Numerical grading of clinical neurological status after serious head injury.

Abstract

A scheme to quantitate the clinical neurological status of the seriously head-injured patient was devised. The neurological parameters used to quantify the degree of injury are based on neurological functions previously accepted as indicators of the severity of the head injury. A numerical value is assigned to each parameter with emphasis on defining the level of consciousness. The accrued point total of each examination represents the neurological status of the patient at that time. Mean values and standard error from the means are determined from repeated examinations during a single 24 h period, and are plotted against days after injury. From this graph a line which represents the rate of clinical recovery is determined by least squares analysis. General intensive care nurses were trained to score patients independently; their determinations were in statistical agreement with scores derived from examinations by the attending physicians. The data highlight the effects of hypoxemia in impeding the rate of neurological recovery from a serious head injury. This simple clinical analytical scheme for the quantitative assessment of patients with head injury permits evaluation of the efficacy of various modes of therapy in altering recovery rate.