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Results for “Persistent Vegetative State”

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PubMed1999

Ethical assessments of brain death and organ procurement policies: a survey of transplant personnel in the United States.

The Questionnaire on Prolonging and Shortening Life was developed to assess the views of medical personnel regarding brain death, organ procurement policies, and related issues. The questionnaire was completed by 189 transplant physicians, 197 clinical coordinators, 150 medical students, and 70 nursing students. Ninety-five percent supported the so-called dead donor rule. What this rule means in practice appeared unclear among the population. More than 60% supported procuring organs from anencephalic and "higher brain-dead" patients, although patients in both groups are not dead by current legal standards. Performance on items relating to so-called non-heart-beating organ donation suggested that 75% of the group do not support non-heart-beating organ donation without assurance that the donors are brain-dead before procurement begins. Given that current recommendations to increase organ donation look to non-heart-beating organ donation rather than to anencephalic patients and those in a persistent vegetative state, these findings suggest that further ethical discussion and analysis are urgently needed.

Adult↗

PubMed1999

Physicians' own preferences to the limitation and withdrawal of life-sustaining therapy.

While limiting and forgoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. Recent studies have demonstrated that physicians frequently attend to their patients without knowledge of their preferences with regards to end-of-life issues. It is postulated that a physician's personal preferences with regard to the limitation and withdrawal of life support and active euthanasia would effect the discussion they had with their patients. The purpose of this study was to analyze end-of-life preferences of a diverse group of practicing physicians. The participants were active attending physicians at a community hospital, a rural referral center, a large tertiary care referral academic complex, and a specialized tertiary care referral center all within the United States. A questionnaire was developed which was mailed to attending physicians at the four participating medical centers. The respondents provided basic demographic data, do-not-resuscitate (DNR) preferences under various clinical circumstances as well as responses to a number of case vignettes. Six hundred and forty physicians responded to the survey. The mean age of the respondents was 46 years; 72% were male. In the event of a cardiac arrest less than 20% of respondents would want to undergo cardiopulmonary resuscitation in the setting of chronic end stage organ failure; the positive response rate was 5% for metastatic cancer and 2% for Alzheimer's disease. If death was imminent, 87% of physicians indicated they would want treatment withdrawn. Similarly, 95% of respondents indicated that they would want treatment withdrawn should they be in a persistent vegetative state. Only 1% of respondents believed that health care providers should never remove or withhold life-sustaining therapy. Should they have advanced motor neuron disease, 38% of physicians indicated they would request that their life be ended. The majority of physicians surveyed volunteered that they would want life-sustaining measures to be limited at the end of their life. A significant number were in favor of active euthanasia. This study suggests that it is unlikely that physicians' personal beliefs in regards to end-of-life care result in the failure to discuss these issues with their patients.

Attitude of Health Personnel↗

PubMedDate not supplied

Chronic persistent nodular polioencephalomyelitis presenting with brain atrophy.

A 61-year-old male had a recurrent fever (approx. 38 degrees C) and one month later, disorientation and forgetfullness became gradually apparent. His mental and somatic status deteriorated progressively with the recurrence of fever; 3 years later he was in a persistent vegetative state accompanied by status epilepticus, and died after 5 years. Mononuclear cytosis (8-20/microliters) and increased protein (20-70 mg/100 ml) were observed in the cerebro-spinal fluid (CSF) at each examination. There was no increase of antibody titers against various viruses, chlamydia, mycoplasma and toxoplasma in the serum and CSF. Neuropathologically, the prominent microscopic finding was patchy scarred foci consisting of neuronal loss replaced by glial tissue throughout the gray matter. A few gliomesenchymal nodules were found. In addition, rod-shaped macrophages were found to varying degrees in all areas of the brain and spinal cord. No viral inclusion bodies were identified. Electron microscopic examination revealed no viral particles in the affected areas. Suspensions of the frozen brain and CSF were inoculated into primary neuron cultures derived from fetal mice and into mouse brains, but the results were negative. There had been five reported cases of chronic nodular encephalitis up until 1971; this case seems to differ from the others by the presence of persistent inflammation and by neuropathologic findings.

Atrophy↗

PubMed1990

[Clinical aspects and intracranial pressure monitoring in cases of traumatic posterior fossa hematoma].

Clinical signs, skull X-P, computerized tomography (CT), continuous monitoring of intracranial pressure (ICP), and serial recording of auditory brainstem response (ABR) were examined in 22 cases of traumatic posterior fossa hematoma. Fifteen of the patients were male and seven were female. Their ages ranged from 3 to 86 years old (mean 35.2 years). The causes of the head injuries were traffic accidents in 13 cases and falls in 9 cases. The site of cranial impact was occipital in all cases but one. Sagittal impact was most common and skull fractures were found in the occipital regions in 19 cases. States of consciousness on admission as measured by the Glasgow coma scale (GCS) were GCS 15 in 2 cases, GCS 9-14 in 9 cases and GCS 3-8 in 11 cases. CT findings of posterior fossa included 10 cases of intracerebellar hematoma, 8 cases of epidural hematoma, 2 cases of combined epidural and intracerebellar hematoma and 2 cases of subdural hematoma. Associated CT findings of the supratentorial region were noted in 18 cases (82%), and most of them showed contrecoup injuries in the frontal region. Six cases of 8 epidural hematomas of the posterior fossa indicated combined epidural hematomas in the occipital region. ICP was monitored in 11 of the 22 cases. Pre-operative ICP monitoring (5 cases) indicated an operative decision. ABR was recorded in 5 cases. Serial ABR recording provides reliable information about brain stem function. The hematoma was evacuated in 15 cases. The Glasgow outcome scale administered 3 months after trauma indicated good recovery in 2 cases, moderate disability in 6 cases, severe disability in 2 cases, persistent vegetative state in 1 case and death in 9 cases. It has become obvious that there are many types of CT findings in posterior fossa hematomas, and that continuous ICP monitoring is very important to determine the timing of surgery and to protect against secondary brain damage caused by increased ICP.

Adolescent↗

PubMed1988

Use of somatosensory evoked responses in the prediction of outcome from coma.

Present data on 60 comatose patients with head trauma, hypoxia and cerebrovascular disease suggested that SER may yield quantitative, useful information concerning the functional state of the cerebral cortex. To assess the prognosis of individual patients we propose to classify patients from various etiologies of coma into the following categories: I. If there is bilateral absence of cortical responses, irrespective of the etiology of coma, none of these patients recover. II. If the initial cortical responses in the first 24 hours are normal, then it is imperative that these should be repeated in the first week before any definitive prognosis can be given, (since as in one case, we noted on the fifth day there was distortion of amplitude of his response and eventually the cortical responses were unobtainable, therefore indicating a poor prognosis). III. Patients who have normal responses throughout the acute course of illness carry an excellent prognosis from coma of all etiologies, except with ischemic etiology. The prognosis remains favorable for recovery from coma, but these patients may remain with significant neurological deficits. IV. When there is a 75% drop in the amplitude of the responses, it indicates a poor prognosis for ultimate neurological recovery, and the majority of these patients will remain in a persistent vegetative state. V. In patients with intermediate reduction in amplitude, 25-50% carried a moderate prognosis, and the majority of these cases in our series were able to perform activities of daily living.

Adolescent↗

PubMed2005

General anesthesia and the neural correlates of consciousness.

The neural correlates of consciousness must be identified, but how? Anesthetics can be used as tools to dissect the nervous system. Anesthetics not only allow for the experimental investigation into the conscious-unconscious state transition, but they can also be titrated to subanesthetic doses in order to affect selected components of consciousness such as memory, attention, pain processing, or emotion. A number of basic neuroimaging examinations of various anesthetic agents have now been completed. A common pattern of regional activity suppression is emerging for which the thalamus is identified as a key target of anesthetic effects on consciousness. It has been proposed that a neuronal hyperpolarization block at the level of the thalamus, or thalamocortical and corticocortical reverberant loops, could contribute to anesthetic-induced unconsciousness. However, all anesthetics do not suppress global cerebral metabolism and cause a regionally specific effect on thalamic activity. Ketamine, a so-called dissociative anesthetic agent, increases global cerebral metabolism in humans at doses associated with a loss of consciousness. Nevertheless, it is proposed that those few anesthetics not associated with a global metabolic suppression effect might still have their effects on consciousness mediated at the level of thalamocortical interactions, if such agents scramble the signals associated with normal neuronal network reverberant activity. Functional and effective connectivity are analysis techniques that can be used with neuroimaging to investigate the signal scrambling effects of various anesthetics on network interactions. Whereas network interactions have yet to be investigated with ketamine, a thalamocortical and corticocortical disconnection effect during unconsciousness has been found for both suppressive anesthetic agents and for patients who are in the persistent vegetative state. Furthermore, recovery from a vegetative state is associated with a reconnection of functional connectivity. Taken together these intriguing observations offer strong empirical support that the thalamus and thalamocortical reverberant network loop interactions are at the heart of the neurobiology of consciousness.

Anesthesia, General↗

PubMed1978

Periventricular leukomalacia in adults. Clinicopathological study of four cases.

The pathological findings in four patients with courses characterized by acute coma and respiratory insufficiency occurring in obscure circumstances are presented. Carbon monoxide intoxication was excluded. After an early partial recovery from coma, the patients remained in a persistent vegetative state, with a tetrapyramidal syndrome. Pathologic changes consisted of infarction and demyelination of periventricular white matter, with associated necrotic foci in the basal ganglia in some cases. We propose that the prolonged hypoxia and ischemia produce a "no reflow" phenomenon causing brain edema (more pronounced in the white matter); this resulted in infarctions of white matter in the periventricular arterial end and border zones.

Adult↗

PubMed1990

Brain glucose metabolism in postanoxic syndrome. Positron emission tomographic study.

Thirteen positron emission tomographic studies of cerebral glucose utilization were carried out in 12 patients with postanoxic syndrome due to cardiac arrest. Seven subjects were in a persistent vegetative state. The 5 other subjects were normally conscious, but disclosed focal neurological signs. When compared with normal values, mean cerebral glucose metabolism was drastically decreased (+/- 50%) in vegetative subjects, and to a lesser degree (+/- 25%) in conscious patients. The most consistent regional alterations were found in the parieto-occipital cortex (9 cases), the frontier between vertebral and carotid arterial territories, followed by the frontomesial junction (5 cases), the striatum (3 cases with dystonia), thalamus (2 cases), and visual cortex (2 cases with cortical blindness). These data suggest that brain anoxia can result in global brain hypometabolism, which appears related to the vigilance state, as well as in regional alterations preferentially located in arterial border zones.

Adult↗

PubMed2004

Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane.

BACKGROUND: Refractory status epilepticus (RSE) is defined as continued seizures after 2 or 3 antiepileptic drugs have failed. Several intravenous agents have been used for RSE; however, problems occur with their toxicity and/or effectiveness. OBJECTIVE: To report our experience with inhalational anesthesia (IA) in patients who were refractory to other antiepileptic drugs. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review during a 4-year period of patients with RSE treated with isoflurane and/or desflurane. MAIN OUTCOME MEASURE: Efficacy of IA on therapy in terminating RSE. RESULTS: Seven patients (4 male) aged 17 to 71 years received 7 to 15 (mean, 10) antiepileptic drugs in addition to IAs. The IAs were initiated after 1 to 103 (mean, 19) days of RSE and were used for a mean +/- SD 11 +/- 8.9 days. All patients received isoflurane, and 1 patient in addition received desflurane anesthesia 21 days after the onset of RSE for a total of 19 days. Regardless of seizure type, isoflurane and desflurane consistently stopped epileptic discharges with adequate, sustained electroencephalographic burst suppression within minutes of initiating IA therapy. Four patients had good outcomes, 3 died (1 of acute hemorrhagic leukoencephalitis, 1 of bowel infarction, and 1 of toxic encephalopathy, who remained in a persistent vegetative state until death 5.5 months after the onset of seizures). Complications during IA therapy included hypotension (7/7), atelectasis (7/7), infections (5/7), paralytic ileus (3/7), and deep venous thrombosis (2/7). No patient developed renal or hepatic dysfunction. CONCLUSIONS: Isoflurane and desflurane adequately suppressed RSE in all cases. Complications were common, but mortality and long-term morbidity were related to the underlying disease and duration of RSE. Prolonged use of isoflurane and desflurane is well tolerated.

Adolescent↗

PubMed1989

'Brain death' and organ retrieval. A cross-sectional survey of knowledge and concepts among health professionals.

A sample of 195 physicians and nurses likely to be involved in organ procurement for transplantation was interviewed about knowledge, personal concepts, and attitudes concerning "brain death" and organ donation. Only 68 respondents (35%) correctly identified the legal and medical criteria for determining death. Personal concepts of death varied widely. Most respondents (58%) did not use a coherent concept of death consistently; others (19%) had a concept of death that was logically consistent with changing the whole-brain standard to classify anencephalics and patients in a persistent vegetative state as dead. The findings demonstrate confusion about correct criteria for determining death and differences in concepts of death that might prove troublesome to the transplantation enterprise. We conclude that health professionals should do more to resolve the clinical and conceptual issues in the definition and determination of death before policies concerning organ retrieval are changed.

Attitude of Health Personnel↗

PubMedDate not supplied

Chronic hyponatremic encephalopathy in postmenopausal women: association of therapies with morbidity and mortality.

CONTEXT: Chronic hyponatremia in postmenopausal women is a common clinical problem often viewed as benign. Fluid restriction is usually the recommended therapy, largely because the extent of morbidity is unknown and because it has been postulated that intravenous (IV) sodium chloride may cause brain damage. OBJECTIVE: To compare IV sodium chloride with fluid restriction in the treatment of postmenopausal women with chronic symptomatic hyponatremia. DESIGN: Nonrandomized prospective study. SETTING: Two university medical centers and affiliated community hospitals. PATIENTS: A total of 53 postmenopausal women with chronic symptomatic hyponatremia (chronic plasma sodium <130 mmol/L in the presence of central nervous system manifestations) treated consecutively from 1988-1997 and followed up for 1 year. The mean (SD) age of the patients was 62 (11) years. INTERVENTIONS: The therapeutic interventions were IV sodium chloride before respiratory insufficiency (n = 17), IV sodium chloride after respiratory insufficiency (n = 22), and fluid restriction only (n = 14). MAIN OUTCOME MEASURES: Morbidity and neurological outcome at 4 months or longer as assessed by cerebral performance category (CPC) in relation to the therapy, initial plasma sodium level, and rate of correction. RESULTS: Chronic symptomatic hyponatremia (mean [SD] sodium level 111 [12] mmol/L) was present for 5.2 [4.5] days. Death or major morbidity occurred in 44 (83%) of 53 patients, including 10 with orthopedic injury. Twelve patients had hypoxemia (PO2 = 63 [25] mm Hg) and cerebral edema. Among patients who received IV sodium chloride before respiratory insufficiency, plasma sodium levels were increased by 22 (10) mmol/L in 35 hours and patients had a CPC of 1.0 (normal or slight disability). Among patients who received IV sodium chloride after respiratory insufficiency, plasma sodium levels were increased by 30 (6) mmol/L in 41 hours and patients had a CPC of 3.0 (1.2) (severe disability). Among patients who had fluid restriction only, plasma sodium levels were increased by 3 (2) mmol/L in 41 hours and patients had a CPC of 4.6 (0.7) (4 = persistent vegetative state; 5 = death). The outcomes did not correlate with either the initial plasma sodium level (r=0.05, P>.12) or the rate of correction (r=0.31, P>.10). CONCLUSIONS: Chronic symptomatic hyponatremia in postmenopausal women can be associated with major morbidity and mortality. Therapy with IV sodium chloride was associated with significantly better outcomes than fluid restriction.

Aged↗

PubMed2000

Barbiturates for acute traumatic brain injury.

BACKGROUND: Raised intracranial pressure (ICP) is an important complication of severe brain injury, and is associated with a high mortality rate. Barbiturates are believed to reduce intracranial pressure by suppressing cerebral metabolism, thus reducing cerebral metabolic demands and cerebral blood volume. However, barbiturates also reduce blood pressure and therefore may adversely effect cerebral perfusion pressure. OBJECTIVES: To assess the effects of barbiturates in reducing raised intracranial pressure, mortality and morbidity in people with acute traumatic brain injury. To quantify any side effects resulting from the use of barbiturates. SEARCH STRATEGY: The review draws largely on the search strategy developed for the Cochrane Injuries Group as a whole. However, in addition the Cochrane Library was searched in December 1996 using the text terms "barbiturate*," "pentobarb*," "phenobarb*," "head," and "brain." An updated search was done in April 1999. SELECTION CRITERIA: Randomised or quasi randomised trials of any one or more of the barbiturate class of drugs (amobarbital, barbital, hexobarbital, mephobarbital, methohexital, murexide, pentobarbital, phenobarbital, secobarbital, thiobarbiturate) where study participants had a clinically diagnosed acute traumatic brain injury of any severity. DATA COLLECTION AND ANALYSIS: The reviewer extracted the data and assessed the quality of allocation concealment in the trials. MAIN RESULTS: The pooled relative risk for death (barbiturate vs no barbiturate) was 1.09 (95%CI 0.81 to 1.47). The pooled effect of barbiturates on adverse neurological outcome, measured using the Glasgow Outcome Scale (death, persistent vegetative state or severe disability) was 1.15 (95% 0.81 to 1.64). Two studies examined the effect of barbiturate therapy on intracranial pressure. In the study by Eisenberger et al, a smaller proportion of patients in the barbiturate group had uncontrolled ICP (68% vs 83%). The relative risk for uncontrolled ICP was 0.81 (95%CI 0.62 to 1.06). Similarly, in the study by Ward et al, mean ICP was lower in the barbiturate treated group. Barbiturate therapy results in an increase in the occurrence of hypotension (RR=1.80 95%CI 1.19 to 2.70). For every four patients treated one will develop clinically significant hypotension. Mean body temperature was significantly lower in the barbiturate treated group. Schwartz et al compared pentobarbital with mannitol in the control of intracranial pressure. Pentobarbital was less effective than mannitol for control of raised ICP. 68% of patients in the pentobarbital treated group required a second drug for the treatment of raised intracranial pressure compared to 39% in the mannitol treated group (RR=1.75 95%CI 1.05 to 2.92). There was no substantial difference in mortality between the two study groups (RR=1.18 95%CI 0.73 to 1.92). REVIEWER'S CONCLUSIONS: There is no evidence that barbiturate therapy in patients with acute severe head injury improves outcome. Barbiturate therapy results in a fall in blood pressure in 1 in 4 treated patients. The hypotensive effect of barbiturate therapy will offset any ICP lowering effect on cerebral perfusion pressure.

Barbiturates↗

PubMed1975

Assessment of severe damage to the brain by multiregional measurements of cerebral blood flow.

Regional cerebral blood flow (rCBF) was measured with a 32-detector device in patients with severe injury to the central nervous system. Most suffered head injiries in traffic accidents. Many patients were severely demented. Several were comatose or in a so-called persistent vegetative state. Flow was measured at rest and during various forms of stimulation. The resting values were on the whole markedly reduced. The flow patterns often showed distinct correlations with the original brain injury. In the best preserved patients, mental activation caused increases in flow with a normal or near-normal distribution. Cutaneous electric stimulation gave rise to increases in cortical flow even in highly reduced patients with severe brain damage. Patients with total or less than total loss of telencephalic structures with retained brainstem reflexes and respiration ('apallic' patients) did not show any changes in flow on sensory stimulation. We conclude that the technique for measuring rCBF enables us to assess severe damage to the central nervous system quantitatively and also to estimate whether higher functions are retained in severely reduced patients in coma, stupor and apallic state--patients who more or less completely lack behavioural responses.

Adolescent↗

PubMed1975

Can one predict outcome of medical coma?

The combined evaluation of the motor response to stimulation and the oculovestibular (OV) reflex gives useful indicants to the outcome of medical coma. We examined 48 patients during the first 12 h and at 24 h after the onset of medical coma. We excluded patients who had ingested drugs or who had hypothermia. Motor responses to a noxious stimulus were scored on a 6 'best' and 1 'worst' scale, and the presence or absence of oculovestibular responses to icewater irrigations was recorded. Subjects were divided by outcome at three months into three groups: death or persistent vegetative state, severe disability, and moderate disability or good recovery. On the basis of the present series it was often possible to distinguish among the outcomes at or before 24 h. The patient's age and the presence or absence of pupillary responses, spontaneous eye movements and oculocephalic responses were not predictive of outcome, nor were the respiratory pattern, blood gases, blood pressure, heart rate and temperature. A minimal motor score and an absence of oculovestibular responses at 12 h always were assoicated with death. With higher motor scores, the absence of oculovestibular responses at either 12 or 24 h implied an outcome no better than severe disability. The results of the present study imply that early bedside assessments can yield accurate predictive information in medical coma.

Cerebrovascular Disorders↗

PubMed1984

Eye movements induced by head rotation in unresponsive patients.

Eye movements induced by head rotation were studied in 6 patients in acute coma, 4 patients in a persistent vegetative state, and 6 healthy, alert control subjects. Results from control subjects suggest that the oculocephalic response in the supine position is principally a vestibulo-ocular reflex. A position-step rotation of the head produced an initial oppositely directed eye movement, followed by a drift of the eyes back toward midline with a negative exponential time course. The time constant of this drift was greater than or equal to 10 seconds in control subjects but less than or equal to 1.5 seconds in unconscious patients and less than or equal to 0.5 seconds in vegetative patients. The rapid drift back of the eyes in unresponsive patients implies dysfunction of reticular and, possibly, cerebellar connections; the rate of this drift may indicate the severity and extent of brain injury. Sinusoidal head rotation produced slow and quick phases of nystagmus in normal subjects. Quick phases were absent in patients in acute coma; although present in vegetative patients, the quick phases did not keep the eyes close to primary position, as was the case in control subjects.

Adult↗

PubMed1987

Caloric-induced nystagmus with isoelectric electroencephalogram.

Caloric vestibular testing induced nystagmus in a patient with an isoelectric electroencephalogram after cardiopulmonary arrest. This has been demonstrated previously in patients in a chronic persistent vegetative state with intact brainstem reflexes, but never in a patient with an isoelectric electroencephalogram. Animal studies indicate that the quick phase of nystagmus and horizontal saccades are generated in the paramedian pontine reticular formation. The present case supports the conclusion that caloric-induced nystagmus originates in the brainstem in rudimentary form.

Brain Death↗

PubMed1997

1H-magnetic resonance spectroscopy-determined cerebral lactate and poor neurological outcomes in children with central nervous system disease.

By using proton magnetic resonance spectroscopy ((1)H-MRS), cerebral lactate has been shown to be elevated in a wide variety of pediatric and adult neurological diseases. In this study we compared 36 newborns, infants, and children with elevated lactate peaks on (1)H-MRS with 61 patients without an identifiable lactate signal. (1)H-MRS was acquired from the occipital gray and parietal white matter (8 cm3 volume, STEAM sequence with echo time = 20 msec, repetition time = 3.0 seconds) and data were expressed as ratios of different metabolite peak areas (N-acetylaspartate [NA]/creatine [Cr], NA/choline [Ch], and Ch/Cr) and the presence of a characteristic lactate doublet peak at 1.3 ppm. Outcomes (Pediatric Cerebral Performance Category Scale score; PCPCS) were assigned 6 to 12 months after injury. Patients with lactate peaks were more likely to have suffered a cardiac arrest, were more often hyperglycemic, and had lower Glasgow Coma Scale scores on admission. They were also more likely to have abnormal metabolite ratios when compared with age-matched controls or with patients without detectable lactate. Of prognostic importance, patients with increased lactate were more likely to be severely disabled (39% vs 10%), survive in a persistent vegetative state (13% vs 2%), or have died (39% vs 7%). In contrast, patients with similar conditions without increased lactate were more likely to have had a good outcome (23% vs 3%) or recovered to a mild (38% vs 6%) or moderate disability (20% vs 0%). Our data suggest that (1)H-MRS is useful in the prediction of long-term outcomes in children with neurological disorders. Patients with elevated cerebral lactate are more likely to die acutely or are at greater risk for serious long-term disability.

Brain Diseases↗

PubMed2026

Analysis of the Relationship between Early Clinical Factors and Glasgow Outcome Scale in Patients With Traumatic Brain Injury.

OBJECTIVE: This study aimed to evaluate the association between early clinical factors and the Glasgow outcome scale (GOS) in patients with traumatic brain injury (TBI). METHODS: We conducted a retrospective analysis of 98 TBI patients who underwent emergency surgery between January 2021 and January 2024. Based on GOS scores at 6 months post-surgery, patients were classified into a favorable outcome group (GOS ≥ 4, defined as moderate disability or good recovery, n = 58) and an unfavorable outcome group (GOS < 4, i.e., death, persistent vegetative state, or severe disability, n = 40). Baseline and early clinical parameters were compared between groups. Statistically significant variables from univariate analysis were entered into a multivariate logistic regression model to identify independent prognostic factors. RESULTS: Significant intergroup differences were observed in age, time from injury to surgery, bleeding site, midline shift, Glasgow coma scale (GCS) score at admission, blood glucose level, and D-dimer level (all p < 0.05). Multivariate analysis confirmed that age, time from injury to surgery, GCS score, blood glucose, and D-dimer level were independent predictors of GOS (all p < 0.05). CONCLUSION: Early clinical factors, including age, time to surgery, GCS score, blood glucose, and D-dimer level, independently influence GOS in TBI patients. Time from injury to surgery emerged as a potentially modifiable factor in this cohort, suggesting that minimizing delays may improve outcomes.

Humans↗