Case-Based Modules > Case 21 > Conclusion

Great job! This patient had an extremely poor exam at the scene of injury and even upon arrival to the ED. She required ICP monitor placement, and she did require intracranial hypertension management for the first few days. Along the way, we were able to identify that her neurologic prognosis was not as grim as might have been considered based on findings such as DAI and unresponsive wakefulness at even the two week time mark.

Pearl 1: GCS and motor exam subscore, as well as DAI, are not reliable predictors of in-hospital mortality.

The updated 2024 NCS guidelines identified the poor level of evidence and unreliability behind findings such as poor GCS and motor exam as predictors of prognosis. Humble et al. also found that DAI is not associated with long-term functional outcomes.


Pearl 2: Even patients with persistent severely depressed mental statuses, such as unresponsive wakefulness, at 2 weeks, who survive to 1 year will all regain consciousness.

The stunning figure is that, of the 62 of the 79 survivors who were unresponsive wakeful at 2 weeks, 100% of them regained consciousness by a year. A truly good functional outcome is very much possible.

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