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a Department
of Neurology, b Department of Neuropsychology, c Department of Endocrinology, University
Hospital Groningen, The Netherlands
Correspondence to: Dr J van der Naalt, Department of Neurology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. Fax 0031 50 3611707; email j.van.der.naalt{at}neuro.azg.nl
Received 30 December
1997 and in revised form 22 June 1998;
Accepted 9 July
1998
OBJECTIVES
To
determine the prognostic value of characteristics of acute injury and
duration of post-traumatic amnesia (PTA) for long term outcome in
patients with mild to moderate head injury in terms of complaints and
return to work.
METHODSPatients with
a Glasgow coma score (GCS) on admission of 9-14 were included.
Post-traumatic amnesia was assessed prospectively. Follow up was
performed at 1, 3, 6, and 12 months after injury. Outcome was
determined by the Glasgow outcome scale (GOS) 1 year after injury and
compared with a more detailed outcome scale (DOS) comprising cognitive
and neurobehavioural aspects.
RESULTSSixty seven
patients were included, mean age 33.2 (SD 14.7) years and mean PTA 7.8 (SD 7.3) days. One year after injury, 73% of patients had resumed
previous work although most (84%) still reported complaints. The most
frequent complaints were headache (32%), irritability (34%),
forgetfulness and poor concentration (42%), and fatigue (45%).
According to the GOS good recovery (82%) or moderate disability (18%)
was seen. Application of the DOS showed more cognitive (40%) and
behavioural problems (48%), interfering with return to work.
Correlation between the GOS and DOS was high (r=0.87, p<0.01). Outcome correlated with
duration of PTA (r=
0.46) but not
significantly with GCS on admission
(r=0.19). In multiple regression analysis,
PTA and the number of complaints 3 months after injury explained 49%
of variance on outcome as assessed with the GOS, and 60% with the DOS.
CONCLUSIONSIn mild to
moderate head injury outcome is determined by duration of PTA and not
by GCS on admission. Most patients return to work despite having
complaints. The application of a more detailed outcome scale will
increase accuracy in predicting outcome in this category of patients
with head injury.
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