Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Prospective assessment
J. H. Ellenberg, H. S. Levin and C. Saydjari
Westat Inc, Rockville, Md, USA.
OBJECTIVES: To identify the demographic and clinical variables related to
the duration of posttraumatic amnesia after severe closed head injury; to
evaluate the usefulness of posttraumatic amnesia duration in predicting
outcome at the time of hospital discharge and at 6 months after injury.
SETTING: Four clinical centers located in primary care hospitals. PATIENTS:
Three hundred fourteen severely injured subjects aged 16 years or older who
did not have trauma as a result of a penetrating injury and came out of
coma before hospital discharge. INTERVENTIONS: Approximately half of the
subjects were administered phenytoin sodium for some period after
termination of coma; 17% were administered dexamethasone and 41% morphine
sulfate. MAIN OUTCOME MEASURES: Galveston Orientation and Amnesia Test
scores defined the duration of posttraumatic amnesia. The Glasgow Outcome
Scale was used to grade outcome at the time of hospital discharge and at 6
months. RESULTS: Older age, low initial Glasgow Coma Scale score,
nonreactive pupil(s), coma duration, and use of phenytoin were associated
with a longer duration of posttraumatic amnesia. Poor pupillary response,
time in coma, and duration of posttraumatic amnesia and use of phenytoin
was predictive of the 6-month outcome. CONCLUSIONS: The results support the
prognostic usefulness of prospectively measuring duration of posttraumatic
amnesia after termination of coma. Pending replication, our findings
suggest that posttraumatic amnesia duration may be a useful surrogate
outcome measure for clinical trials involving interventions for acute head
injury.
