Pupillary abnormality on admission and brain bulging during surgery as unfavourable predictors in patients treated with hypothermia: a retrospective review of 81 patients with severe head injury.

Abstract

To determine factors predicting outcome of patients with severe head injury, the authors retrospectively analyzed 81 patients, 3 to 70 years of age, who were treated by hypothermia. The initial Glasgow Coma Scale scores of the 81 patients ranged from 3 to 8. Outcome in each case was determined at six months after injury and was retrospectively analyzed with respect to patient characteristics, initial clinical status, laboratory data, computed tomographic findings, data from monitoring, intra-operative findings, and treatment methods. The significance of clinical and neuroradiological factors for predicting unfavorable outcome was analyzed by univariate logistic regression. Stepwise multiple logistic regression analysis was then used to identify independent predictors of outcome. Favorable outcome was observed in 27 of 81 patients treated by hypothermia. Independent factors predicting unfavorable outcome included pupillary abnormality on admission and brain bulging during surgery. Therapeutic effectiveness of hypothermia was thus limited in patients who presented with these grave symptoms.