IMPROVED CONFIDENCE OF OUTCOME PREDICTION IN SEVERE HEAD-INJURY - A COMPARATIVE-ANALYSIS OF THE CLINICAL EXAMINATION, MULTIMODALITY EVOKED-POTENTIALS, CT SCANNING, AND INTRA-CRANICAL PRESSURE
IMPROVED CONFIDENCE OF OUTCOME PREDICTION IN SEVERE HEAD-INJURY - A COMPARATIVE-ANALYSIS OF THE CLINICAL EXAMINATION, MULTIMODALITY EVOKED-POTENTIALS, CT SCANNING, AND INTRA-CRANICAL PRESSURE
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DOI：
10.3171/jns.1981.54.6.0751
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发表时间：
1981-01-01
影响因子：
4.1
通讯作者：
BECKER, DP
中科院分区：
文献类型：
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作者：
NARAYAN, RK;GREENBERG, RP;BECKER, DP
对133例严重颅脑损伤患者的临床体征（单独或组合）、多模态诱发电位（MEP）、计算机断层扫描和颅内压（ICP）数据进行了前瞻性分析，以确定这些指标单独或以各种组合预测2种结局中的1种的准确性、可靠性和相对价值。分析错误的预测，无论是错误的乐观（FO）或错误的悲观（FP），以获得对疾病过程的病理生理学见解。FO预测发生是因为不可预测的并发症，但FP预测是由于内在的弱点的指标作为解释。结合临床资料，包括年龄、格拉斯哥昏迷评分（GCS）评分、瞳孔反应、手术肿块病变的存在、眼外运动和运动姿势预测结果的准确性为82%，43%，置信度超过90%。9%的预测是FO和FP。单独的GCS评分在80%的预测中是准确的，但置信度较低（在90%以上的水平为25%），FO为7%，FP为13%。孤立的计算机断层扫描和ICP数据是预后不良的指标。当单独与临床数据结合时，他们将90%以上置信度的预测数量分别增加到52%和55%。MEP的数据代表了最准确的单一预后指标，91%的正确预测，25%的置信水平超过90%。没有与该指标相关的FP错误。补充MEP数据的临床检查产生了最佳的预后能力，89%的准确率，64%的90%的置信水平和4%的FP错误。临床检查仍然是预测重型颅脑损伤预后的最有力的依据，但更多的研究增强了这种预测的可靠性。
An analysis of clinical signs, singly or in combination, multimodality evoked potentials (MEP), computerized tomography scans and intracranial pressure (ICP) data was undertaken prospectively in 133 severely head-injured patients to ascertain the accuracy, reliability and relative value of these indicants individually, or in various combinations, in predicting 1 of 2 categories of outcome. Erroneous predictions, either falsely optimistic (FO) or falsely pessimistic (FP), were analyzed to gain pathophysiological insights into the disease process. FO predictions occurred because of unpredictable complications, but FP predictions were due to intrinsic weakness of the indicants as prognosticators. A combination of clinical data, including age, Glasgow Coma Scale (GCS) score, pupillary response, presence of surgical mass lesions, extraocular motility and motor posturing predicted outcome with 82% accuracy, 43% with over 90% confidence. Nine percent of predictions were FO and FP. The GCS score alone was accurate in 80% of predictions, but a lower level of confidence (25% at the over-90% level), with 7% FO and 13% FP. Computerized tomography and ICP data in isolation were poor prognostic indicants. When combined individually with clinical data, they increased the number of predictions made with over 90% confidence to 52 and 55%, respectively. Data from MEP represented the most accurate single prognostic indicant, with 91% correct predictions, 25% at the over-90% confidence level. There were no FP errors associated with this indicant. Supplementation of the clinical examination with MEP data yielded optimal prognostic power, an 89% accuracy rate, with 64% over the 90% confidence level and 4% FP errors. The clinical examination remains the strongest basis for prognosticating outcome in severe head injury, but additional studies enhance the reliability of such predictions.