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Neurosurgery. 1982 Sep;11(3):344-51.

Moderate head injury: completing the clinical spectrum of brain trauma.


We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy-five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space-occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90%; difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead-Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty-six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio-economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis, GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and

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