Gomez et al developed a score for predicting early mortality in a patient with severe head trauma. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in Spain.
Patient selection: closed severe head trauma, age 15 to 95 years
Outcome: early mortality
Parameters:
(1) age in years
(2) motor score (none, untestable, extensor, abnormal flexion, withdrawal, localize)
(3) pupillary reactivity, from 0 to 2
(4) shock
(5) subarachnoid hemorrhage (SAH)
(6) cisternal status on imaging studies
(7) epidural hematoma
Parameter
Finding
Points
age in years
76 to 95 years
3
56 to 75 years
2
36 to 55 years
1
15 to 35 years
0
motor score
none
3
untestable
2
other
0
pupillary reactivity
neither
6
one
2
both
0
shock
absent
0
present
2
SAH
severe
1
none to moderate
0
cisternal status
absent or compressed
3
other
0
epidural hematoma
none
2
present
0
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the worse the early death.
Total Score
Risk Group
Mortality
0 to 3
low
< 1%
4 to 8
moderate
1 to 10%
9 to 12
high
10 to 50%
13 to 20
very high
> 50%
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