Severe Head Injury: Prognostic Factors and Clinical Management

Head injury is a very frequent event, associated with high morbidity rates. Classically, more attention has been paid to severe injury. The aim of this study was to describe a large series of adult patients, older than 14 years, who suffer severe head injury, treated at the University Hospital of Getafe, between 1993 and 2015 (n=86), to study the epidemiological profile, and to analyze the best diagnosis and the treatment carried out, as well as establishing the main prognostic factors that influence the final result. A retrospective study of review of medical records has been carried out, and also hospital consultation. In this study, the variables that have been most determinant of the adverse evolution in the patient suffering from severe head injury are age, size and pupillary reactivity, the worst score obtained by the patient on the Glasgow Coma Scale (GCS) and the lesions found in the Computed Tomography (CT) of the skull. Lesions in severe head injury can be categorized into nine pathological patterns according to the information provided by the CT. These patterns present an anatomical and clinical profile and a well-defined prognostic significance, associated in turn with a behavior pattern of ICP characteristic. Pure extra-axial hematomas are the lesions that present the best prognosis, being the diffuse axonal lesion associated with brain swelling and multiple bilateral contusions which lead to worse evolution. The Rimel Scale correctly adjusts to the severity of head injury. The Glasgow Coma Scale is well related to the final prognosis of the patient with severe head injury.