Article
Anisocoria in the emergency room: prognostic factors for clinical outcome
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Authors
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Sebastian Haus
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
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Frank Mielck
- Anästhesiologie, Georg-August-Universität Göttingen, Deutschland
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Veit Rohde
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
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Angelika Gutenberg
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Patients showing anisocoria due to head trauma (HT) or spontaneous intracranial hemorrhage (SIH) require immediate evaluation and neurosurgical intervention. This study is focused on the prognosis and adverse prognostic factors for mortality and functional outcome in these patients.
Methods: This is a case-control study of 247 patients with anisocoria due to increased intracranial pressure which were admitted to our emergency room. We compared the patients´ demographic and clinical data with the mortality at time of discharge from the intensive care unit, using a multiple logistic regression analysis. The clinical data were collected retrospectively between January 1995 and September 2009. Exclusion criteria were known physiological anisocoria, an observed anisocoria during epileptic seizure or cardiopulmonary recuscitation. spontaneous regression of anisocoria, bulbus trauma or occulomotoric palsy.
Results: 175 patients met the inculsion criteria (99 male, 76 female). 93 patients were admitted with HT, 82 with SIH. All showed anisocoria at the time of admittance to the emergency room. Generally, patients with HT had a better chance of survival (p=0.0147). Of 57 (61.3%) survivors with HT, 23 (43.4%) had a KPS >70%. 33 (40.2%) patients with SIH survived, only 11 (33.3%) of these with a KPS of >70%. Of 14 proposed variables tested, 7 lacked prognostic value. When the other 7 predictors were analyzed in a multiple logistic regression model, 3 remained significant as adverse predictors of outcome in patients with HT (systolic blood pressure >160 mmHg measured at accident (OR 12.67), age older than 65 years (OR 9.8), and anticoagulative treatment (OR 4.48). In patients with SIH, solely age older than 65 years (OR 4.45) remained a significant adverse prognostic factor for survival.
Conclusions: Patients with anisocoria due to severe head trauma have a more favorable clinical outcome than those suffering from spontaneous intracranial bleeding. Adverse prognostic factors in head trauma are patients age >65 years, anticoagulant treatment and systolic blood pressure >165 mmHg measured at accident.
