Factores clínicos y de neuroimagen asociados con el pronóstico del traumatismo craneoencefálico moderado

OBJECTIVE: To determine the main clinical and radiological factors associated with the prognosis of patients suffering moderate head injury. METHODS: A retrospective study of patients older than 14 years suffering moderate head injury treated at the University Hospital of Getafe (Madrid) between 2005 and 2015 was performed. Four groups were established, using the Glasgow Coma Scale (GCS), to describe the main clinical and radiological variables associated with short-term prognosis. The means and the percentages were determined, and a bivariate analysis was carried out. Consequently, a clinical action scheme is designed based on the factors previously analyzed. RESULTS: The sample was 66 patients. Moderate head injury was more frequent in males (57 patients), and the most frequent causative mechanism was traffic accident (33 patients). Clinical deterioration are especially diffuse axonal lesion with edema or concussion. In the multivariate study (linear regression), the existence or not of neurological focality (regression coefficient: 0.884), the findings in the control TC (regression coefficient: 0.499), the findings in the initial TC (regression coefficient: 0.174) and the Age (Regression coefficient: 0.033) are significant (p < 0.001) in reference to the final evolution. It was different the prognosis of patients with score of 11 and 12 with respect to those who obtain 9 and 10 points in the ECG. However, the GCS is not associated directly to the evolution of the patient suffering moderate head injury. CONCLUSIONS: Factor associates with the prognosis of patients suffering moderate head injury are abnormal findings on CT described above, the existence of neurological focality, the presence of clinical deterioration, advanced age, the findings on the control CT, and run over, drop and direct impact as causal mechanisms, influence the final outcome. The need for hospital admission were establish, either in the Neurosurgery room or in the Intensive Care Unit, depending of clinical-CT scan findings.