Ch 2 - TBI: Prognosis Flashcards
Describe the motor response scores for GCS.
1- None 2- Decerebrate posturing to pain 3- Decorticate posturing to pain 4- Withdraws limbs to pain 5- Localizes to pain 6- Obeys verbal commands
Describe the verbal response scores for GCS.
1- None 2- Unitelligible sounds 3- Inappropriate words 4- Confused 5- Alert and oriented
Describe the eye opening scores for GCS.
1- None
2- Opens to pain
3- Opens to loud voice
4- Opens spontaneously
What is the severity of TBI based on GCS score?
Severe: 3 to 8
Moderate: 9 to 12
Mild: 13 to 15
At what GSC score is a patient considered comatose?
GSC <8
Which GCS category is the best acute predictor of outcome in TBI?
Best motor response
What is the Fronto-orbicular reflex?
Orbicularis oculi contraction on percussion of the glabella
What is the Oculocardiac reflex?
Bradycardia induced by increasing pressure on the eyeball
Describe the relationship between length of coma and disability.
Coma <2 weeks: Severe disability unlikely
Coma >4 weeks: Good recovery unlikely
When does the resolution of Posttraumatic amnesia (PTA) occur?
Incorporation of ongoing daily events occurs in the working memory
Describe the relationship between length of PTA and disability.
PTA <2 mo: severe disability unlikely
PTA >3 mo: good recovery unlikely
What is the Galveston Orientation and Amnesia Test (GOAT)?
Structured interview that quantifies the patient’s orientation and recall of recent events to assess PTA
What score on GOAT defines the end of PTA?
Score 75 or > for 2 consecutive days
What is the length of PTA defined by?
of days beginning at the end of the coma to the time the patient attains the first of two successive GOAT scores >75
At what GOAT score do neuropsychological assessments become productive?
Consistent scores >70
What is the severity of TBI based on duration of PTA?
Very mild: <5 min Mild: 5-60 min Moderate: 1-24 hr Severe: 1-7 days Very severe: 1-4 weeks Extremely severe: >4 weeks
How does age affect TBI prognosis?
Higher mortality: <5 yo and >65 yo
Children and young adults have more positive prognosis
Which parts of the eye exam indicate good prognosis in TBI?
Reactive pupils
Conjugate eye movement
What period does most recovery happen after TBI?
First 6 months post-injury
Which posturing has a better prognosis?
Decorticate>decerebrate or flaccid tone
What is the disability rating score?
30-point scale of 8 dimensions developed specifically for brain injury providing quantitative index of disability
What are the 8 dimensions of the disability rating score?
- Eye opening
- Verbalization/communication 3. Motor responsiveness
- Feeding*
- Toileting*
- Grooming*
- Overall level of functioning/dependence
- Employability
* Measuring cognitive skills only in these categories
What is a Rancho Los Amigos Level I?
No response
What is a Rancho Los Amigos Level II?
Generalized response to stimulation
