Hukkelhoven et al developed models for predicting outcome following moderate or severe traumatic brain injury. The scores can help identify patients who may require more aggressive management using findings identified on hospital admission. The authors are from Erasmus Medical College in Rotterdam, University of Virginia, Virginia Commonwealth University, University of Edinburgh, and University of California in San Diego.
Patient selection: age >= 15 years
Unfavorable outcomes at 6 months post-injury:
(1) death
(2) vegetative state
(3) severe disability on Glasgow Outcome Scale
Parameters based on admission findings:
(1) age
(2) motor score
(3) papillary reactivity
(4) hypoxia
(5) hypotension
(6) CT classification
(7) traumatic subarachnoid hemorrhage
|
Parameter |
Finding |
Score 1 |
Score 2 |
|---|---|---|---|
|
age in years |
15 - 39 |
0 |
0 |
|
|
40 - 54 |
1 |
1 |
|
|
55 - 64 |
2 |
2 |
|
|
>= 65 |
3 |
3 |
|
motor score |
localizes or obeys |
0 |
0 |
|
|
withdraws |
1 |
1 |
|
|
abnormal flexion |
2 |
2 |
|
|
extensor |
3 |
3 |
|
|
none |
3 |
3 |
|
papillary reactivity |
both react |
0 |
0 |
|
|
1 reacts |
1 |
1 |
|
|
0 react |
2 |
2 |
|
hypoxia |
PaO2 >= 60 mm Hg |
0 |
0 |
|
|
PaO2 < 60 mm Hg |
1 |
1 |
|
hypotension |
systolic >= 90 mm Hg |
0 |
0 |
|
|
systolic < 90 mm Hg |
2 |
1 |
|
CT classification |
Class I (no visible pathology) |
0 |
0 |
|
|
Class II (midline shift 1-5 mm) |
0 |
0 |
|
|
Class III (cisterns absent or compressed with midline shift 1-5 mm) |
2 |
1 |
|
|
Class IV (midline shift > 5 mm) |
4 |
1 |
|
|
Class V (any lesion surgically evacuated) |
2 |
1 |
|
|
Class VI (high or mixed density lesion > 25 mm not surgically evacuated) |
2 |
1 |
|
traumatic subarachnoid hemorrhage |
absent |
0 |
0 |
|
|
present |
2 |
1 |
where:
• Details of the complete prognostic models are given in the Appendix on page 1037 (Hukkelhoven, J Neurotrauma, 2005).
• The CT classification is based on that of Marshall et al (1991)
score 1 for predicting 6 month mortality =
= SUM(points for all 7 parameters in score 1 column)
score 2 for predicting unfavorable outcome at 6 months =
= SUM(points for all 7 parameters in score 2 column)
Interpretation:
• minimum scores: 0
• maximum score 1 (mortality): 17
• maximum score 2 (unfavorable outcome): 12
• The higher the scores the worse the outcome.
|
Score 2 |
Outcome |
Risk of Unfavorable Outcome |
Mean Mortality Rate |
|---|---|---|---|
|
0 - 2 |
good |
0 - 20% |
7% |
|
3 |
relatively good |
21 - 40% |
15% |
|
4 - 5 |
intermediate |
41 - 60% |
30% |
|
6 - 7 |
poor |
61 - 80% |
47% |
|
8 - 12 |
very poor |
81 - 100% |
68% |
|
Total Score |
Score 1 (Probability of Mortality) |
Score 2 (Probability of an Unfavorable Outcome) |
|---|---|---|
|
0 |
3% |
8% |
|
1 |
5% |
13% |
|
2 |
8% |
22% |
|
3 |
10% |
33% |
|
4 |
14% |
46% |
|
5 |
19% |
60% |
|
6 |
26% |
73% |
|
7 |
33% |
83% |
|
8 |
42% |
91% |
|
9 |
52% |
95% |
|
10 |
62% |
97% |
|
11 |
71% |
99% |
|
12 |
78% |
100% |
|
13 |
85% |
NA |
|
14 |
89% |
NA |
|
15 |
95% |
NA |
|
16 |
98% |
NA |
from Figure 2, page 1034, Hukkelhoven et al, J Neurotrauma (2005)
Performance:
• The score used large number of patients and a large number of predictors. It underwent internal and external validation.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Otolaryngology
ICD-10: ,
