Outcome after severe head injury: focal surgical lesions do not imply a better Glasgow Outcome Score than diffuse injuries at 3 months

We prospectively recorded the Glasgow Outcome score (GOS), at 3 months, of all the severely head injured patients treated at our institution over a two and a half year period. Of 116 patients admitted with an initial Glasgow Coma Score (GCS) of 8 or less, 58 had surgical lesions and 58 non-surgical head injuries. The two groups were well matched for presenting GCS and age. Overall our favourable outcome rate (GOS 4 and 5) at 3-months for the patients with a surgical lesion and for the non-surgical group were 47.3% and 46.6% respectively, with no significant difference between the two (P = 0.54).The assumption in the past has always been that patients presenting in coma from traumatic diffuse brain injury will do worse than those that have a mass lesion amenable to surgical decompression. Our series would suggest that this is not the case and all severely head injured patients should expect similar outcome when cared for in a neuroscience centre.It is well accepted that prompt surgical decompression of traumatic intracranial haematomas leads to improved outcomes for head injured patients. [1-3] In keeping with this, recent prognostic models have identified non-evacuated intracranial haematomas as strong predictors of poor outcome in severe head injured patients.[4] As such, it is usual for patients with traumatic intracranial mass lesions to be transferred to a neurosciences centre for surgery and neurointensive care.Conversely, due to lack of infrastructure, patients deemed to have non-surgical head injuries have often been managed outside of neuroscience centres. This approach to allocating limited resources is based on a long-held belief that individuals with focal surgical lesions will do better than those with diffuse injuries. Indeed, contemporary data predicts that individuals with extradural haematomas (EDH) will do better than patients with other types of severe closed head injury.[5] This is intuitive because an EDH compromises neural function by compressio