Prognosis After TBI

Question 1

Lower GCS score is associated with worse outcomes based on the best GCS within what time frame?

Answer 1

1st 24 hours

Question 2

What is the cutoff of GCS for patient to be considered comatose

Answer 2

<8

Question 3

Age of TBI and prognosis

Answer 3

Younger people have better prognosis than older people

Question 4

Mild vs moderate vs severe TBI based on GCS

Answer 4

Mild = 13-15
Moderate = 9-12
Severe = 3-8

Question 5

Severity of PTA and prognosis of TBI

Answer 5

Very mild, mild and moderate = quick and full recovery
Severe = full recovery but prolonged rehab
Very severe = some residual deficits and rehab months to years
Extremely severe = permanent deficits and significant disability

Question 6

Severe disability vs good recovery and duration of coma

Answer 6

Severe disability is unlikely if coma <2 weeks.

Good recovery is unlikely if coma >4 weeks.

Question 7

Duration of PTA and severe disability vs good recovery

Answer 7

Severe disability is unlikely if PTA is <2 months.

Good recovery is unlikely if PTA is >3 months.

Question 8

Duration of PTA and prognosis

Answer 8

< 1 day = quick and full recovery
1-7 days = full recovery but prolonged rehab
1-4 weeks = some residual deficits and rehab months to years
>4 weeks = permanent deficits and significant disability

Question 9

What test is used to objectively measure personality

Answer 9

Minnesota Multiphasic Personality Inventory

Question 10

What is the oculocardiac reflex

Answer 10

Putting pressure on the eye causes bradycardia

Question 11

What score on the GOAT does the patient need to have in order to mark the end of PTA?

Answer 11

75 or higher for 2 consecutive days

Question 12

6 categories of duration of PTA and severity of TBI

Answer 12

<5 min = very mild
<1 hour = mild
<1 day = moderate
<1 week = severe
<1 month = very severe
>1 month = extremely severe

Question 13

What kind of eye response indicates good prognosis

Answer 13

Conjugate eye movement

Question 14

Most recovery occurs within the first ________ post-injury

Answer 14

6 months

Question 15

What portion of the GCS (motor, verbal, eye) is the best acute predictor of outcome

Answer 15

Motor response

Question 16

When does period of PTA start and end

Answer 16

Period of PTA starts at end of coma and PTA ends when patient score 75 or higher on the GOAT or 25 or higher on O-log for 2 consecutive days

Question 17

GCS > _______ is good prognosis

Answer 17

> or equal to 8

Question 18

What indicates resolution of posttraumatic amnesia

Answer 18

When ongoing daily events can be incorporated in working memory

Question 19

What is the fronto-orbicular reflex?

Answer 19

Percussing the glabella results in contraction of the orbicularis oculi

Question 20

What 4 reflexes can be used to determine prognosis of TBI

Answer 20

1. Fronto-orbicular reflex
2. Vertical and horizontal oculocephalic reflex (dolls eyes)
3. Pupillary light reflex
4. Oculocardiac reflex

Question 21

What indicates good prognosis with caloric testing with ice water

Answer 21

Eyes deviate towards the irrigated side

Question 22

What test is used to measure IQ

Answer 22

WAIS-R (Wechsler Adult Intelligence Scale)

Question 23

What score does the patient need to get on the Orientation-Log to mark the end of PTA?

Answer 23

25 or higher for 2 consecutive scores

Question 24

What does the Galveston Orientation and Amnesia Test measure?

Answer 24

It is used to assess posttraumatic amnesia