Predicting short term functional outcome in acute head injured patients

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Predicting short term functional outcome in acute head injured patients

 

Author: Chan, Wing-chiu
Title: Predicting short term functional outcome in acute head injured patients
Degree: M.Sc.
Year: 1997
Subject: Brain -- Wounds and injuries -- Patients
Brain damage -- Patients
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Pages: ix, 66 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1410556
URI: http://theses.lib.polyu.edu.hk/handle/200/684
Abstract: This study intended to find out the correlation of the physical functional outcomes in transfer, ambulation and stair climbing, measured by the modified Barthel Index, with the 'predictors' (age, Glasgow Coma Scale on admission, day 1, day 2, and day 7, degree of midline shift of brain on CT brain scan, and the peak intracranial pressure) in acute head injured patient during acute hospitalization. Thirty three patients who were admitted for head injury, free from spinal injury, independent in daily activities before the accident, and had no previous history of neurological problems, were involved in the study. Information on the age (age), the highest Glasgow Coma Scale (GCS) scores on admission day, day 1, day 2 and day 7 after admission and on discharge, the peak intracranial pressure (ICP max.), were taken directly from the medical record and the neuro-observation chart. The amount of midline shift of brain on the initial CT brain scan (CT MLS) was measured using a standard tape measure by the therapist. Assessment on the physical functional outcome using the modified Barthel Index was performed first when the patient was allowed to sit out of bed (BI sit) and again when the patient was ready for discharged (BI d/c). The total length of stay in acute hospital was recorded (LOS d/c). Correlation analysis and multiple regression analysis were used to study the correlation and the strength of prediction between the 'predictors' and the physical functional outcome. The level of significance was set at p < 0.05. The mean GCS score of the patient improved from 12.3 (S.D. 3.38) at the time of admission to 13.39 (S.D. 3.77) on discharge. The mean BI score on physical functional outcome at the time of sitting out was 23.94 (S.D. 13.89) and improved to 31.33 (S.D. 13.67) when patients were discharged from the hospital. The mean length of hospitalization is 25.16 (S.D. 34.00). Analysis of data recorded showed that all the Glasgow Coma Scale scores measured on admission, day1, day2, day7 were correlated with the physical functional outcome on sitting out and inversely correlated with the length of hospitalization( BI sit - GCS scores: r = 0.409 to 0.613, p < 0.05; LOS d/c - GCS scores : r = -0.527 to -0.665, p < 0.05). The physical functional outcome on discharge was correlated with the Glasgow Coma Scale scores only on day2 and day 7( BI d/c - GCS d2: r = 0.346, BI d/c - GCS d7: r = 0.641, p < 0.05 ). There was an increasing trend of correlation strength between the GCS scores and the physical functional outcomes and the length of hospitalization from the day of admission to day 7 ( r value of BI sit Vs GCS scores increases from 0.409 to 0.613; r value of BI d/c Vs GCS scores increases from 0.346 to 0.641; r value of LOS d/c Vs GCS scores increases from -0.529 to -0.665, p < 0.05), implying that the later GCS scores were better in prediction of outcome. This study showed that age was fairly correlated with the physical functional outcome on discharge ( r = -.495, p <.005). The peak intracranial pressure was found significantly correlated with the physical functional outcome on sitting out and on discharge (r = 0.246, r = 0.210, p < 0.05), however, the strength of correlation was too weak for clinical prediction. The amount of midline shifting of brain was not correlated with all the outcomes variables. In the regression analysis, only the GCS score on day 7 was found to be a significant predictor for the physical functional outcome on sitting out (R 2 = 0.285, p < 0.005)and the length of stay (R 2 = 0.566, p < 0.0005). Both the age and the GCS score on day 7 were significant predictors for the physical functional outcome on discharge (R 2 = 0.535, p < 0.0005). However, the predictive strength of age and the GCS on day 7 were fair to moderate only (R 2 ranges from 0.285 to 0.566 ) and therefore have limited value in the clinical application. The weak correlation between the predictors ( ICP and amount of mid-line shift of brain) and the outcome could be due to a small sample size in this study. Further study with larger scale of sampling was necessary.

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