Clinical Analysis of the Risk Factors and Prognostic Factors of Delayed Deterioration Following Mild Head Injury.

Choi, Seung Won; Koh, Hyeon Song; Yeom, Jin Young; Kim, Seong Ho; Song, Shi Hun; Kim, Youn

Original Article

Journal of Korean Neurosurgical Society 1999;28(9): 1316-1323.

Seung Won Choi, Hyeon Song Koh, Jin Young Yeom, Seong Ho Kim, Shi Hun Song, Youn Kim

Department of Neurosurgery, College of Medicine, Chungnam National University, Taejeon, Korea.

ABSTRACT

OBJECTIVE
The objective of this study was to analyze the clinical course of mild head injury patients and to investigate the risk and prognostic factors of delayed deterioration.
METHODS
We retrospectively studied 366 consecutive patients with Glasgow Coma Scale scores ranging from 13 to 15 who were admitted to the neurosugery department from January 1995 to December 1997.
RESULTS
Among 51(13.9%) patients with delayed deterioration, 13(25.5%) died and 36(70.6%) patients had favorable outcomes. Statistically correlated risk factors of delayed deterioration were: old age, drowsiness or speech disturbance, a low GCS score, abnormal laboratory findings including coagulopathy, electrolyte imbalance, hyperglycemia, and presence of subdural hematoma in initial brain CT. Twentyeight(54.9%) patients with delayed deterioration underwent neurosurgical intervention and 229(72.1%) patients without delayed deterioration were treated conservatively. Only sex, age and the GCS score on admission or deterioration were statistically correlated with prognosis of delayed deteriorated patients.
CONCLUSION
Delayed deterioration following mild head injury may need an urgent operation, or lead to serious complication or disability. Therefore, physicians treating these patients must aware of the risk factors and prognostic factors of delayed deterioration to prevent more serious sequelae or to make an early diagnosis allowing for proper treatment. We also recommend special caution in patients with the abovementioned risk factors to ensure a even better prognosis for patients with mild head injury.

Key Words: Mild head injury; Delayed deterioration; Risk factor; Prognosis