Risk factors in severe head injuries.

A total of 472 consecutive patients with severe head injuries (Glasgow Coma Scale score 8 or below) were studied for assessment of various risk factors affecting the outcome. The patients were divided into two groups - 299 (63 percent) patients who died and 173 (37 percent) patients who survived. Each risk factor pretraumatic, traumatic and post traumatic which might have affected the outcome was compared in each group. The following risk factors significantly increased the chances of mortality : (i) Pretraumatic - advanced age, presence of pre existing disease, (ii) Traumatic - GCS score less than 8, presence of shock, dilated pupil with an abnormal light reaction, motor disturbances, extensor rigidity, no reaction to pain, intracranial space occupying lesions (CT scan abnormalities), additional injuries, and (iii) Post traumatic - alternations in blood pressure, presence of biochemical abnormalities, hypoxia and the need for endotracheal intubation and mannitol infusion.