Calculated recovery rates in severe head trauma

M. Salcman, R. S. Schepp, T. B. Ducker

Research output: Contribution to journalArticle

Abstract

In a series of 120 head-injured patients, recovery rates (rr) were calculated separately on the basis of either Glasgow coma scale (GCS) scores or Maryland coma scale (MCS) scores; the latter contains the three variables of the GCS, excludes unevaluable responses, and provides more information concerning the status of brain stem reflexes and motor lateralization. The early (Day 3/4 vs. Day 1) and late (Day 8/14 vs. Day 1) recovery rates from the two scales generally agree (r = 0.76; r = 0.79), but in 39 of 94 patients the MCSrr and GCSrr disagreed by more than 10%. When the MCSrr was greater than the GCSrr, it more accurately reflected a favorable outcome. Graphic representations of clinical courses through serial plots of raw scores were more reliable when unaffected by intubation, sedation, swollen eyelids, casts, etc.; this was more often achieved with serial plots of MCS scores, which are graded as percentages of testable function. Final outcomes (good/disabled vs. vegetative/dead) were well predicted by Day 1 MCS scores above or below 35% (χ2 = 27.63; P <0.001) and Day 1 GCS scores above or below 7 (χ2= 23.21; P <0.001). However, in 57 very sick patients (Day 1 GCS ≤7), the GCS did no better than chance (26 good, 31 bad outcomes), whereas 20 of 26 patients with a Day 1 MCS score of ≤35% had bad outcomes. In patients with severe multiple injuries, the Maryland coma scale may provide a more sensitive index of clinical course; a Day 1 MCS raw score of ≤35% is of grave prognostic significance.

Original languageEnglish (US)
Pages (from-to)301-308
Number of pages8
JournalNeurosurgery
Volume8
Issue number3
StatePublished - 1981
Externally publishedYes

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Coma
Glasgow Coma Scale
Craniocerebral Trauma
Sick Leave
Multiple Trauma
Eyelids
Intubation
Brain Stem
Reflex
Head

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Salcman, M., Schepp, R. S., & Ducker, T. B. (1981). Calculated recovery rates in severe head trauma. Neurosurgery, 8(3), 301-308.

Calculated recovery rates in severe head trauma. / Salcman, M.; Schepp, R. S.; Ducker, T. B.

In: Neurosurgery, Vol. 8, No. 3, 1981, p. 301-308.

Research output: Contribution to journalArticle

Salcman, M, Schepp, RS & Ducker, TB 1981, 'Calculated recovery rates in severe head trauma', Neurosurgery, vol. 8, no. 3, pp. 301-308.
Salcman M, Schepp RS, Ducker TB. Calculated recovery rates in severe head trauma. Neurosurgery. 1981;8(3):301-308.
Salcman, M. ; Schepp, R. S. ; Ducker, T. B. / Calculated recovery rates in severe head trauma. In: Neurosurgery. 1981 ; Vol. 8, No. 3. pp. 301-308.
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