Risk stratification in mild head injury patients: the head injury predictive index.

Department of Neurosurgery, Louisiana State University, New Orleans, USA.

BACKGROUND: Mild Head Injury has classically been defined as patients with a Glasgow Coma Scale (GCS) of 13 to 15. While most of these patients do well, some suffer serious outcomes. The objective of this study was to identify the group at high risk for poor outcome. METHOD: Analysis of 255 consecutive patients who presented to the Medical Center of Louisiana at New Orleans with GCS from 13 to 15 was performed. A new Head Injury Predictive Index (HIPI) based on Focal Neurological Signs, the verbal response and eye-opening components of the GCS, and CT findings was used to stratify patients into "high" and "low" risk groups. RESULTS: There were 10 in-hospital decompensations and 7 poor outcomes at discharge. The study shows that the HIPI was predictive of both poor outcomes and in-patient decompensations. CONCLUSION: When compared to GCS, the inclusion of computed tomographic and focal neurological data gives the HIPI more power in predicting poor outcome and in-hospital decompensations in the mild head injury group.

PMID: 14750754 [PubMed - indexed for MEDLINE]