British journal of neurosurgery
-
Comparative Study
The Apache II scoring system in neurosurgical patients: a comparison with simple Glasgow coma scoring.
In order to compare the predictive value of the Apache II, the Glasgow Coma Scale and Revised Trauma Scoring systems in relation to outcome in a neurosurgical department high dependency unit (HDU), all 109 patients entering the unit under the care of one consultant were studied. All patients in the HDU were self-ventilating, so that motor responses were not suppressed by muscle relaxants or sedation. Initial Minimum and Maximum Glasgow Coma Scale Scores, Revised Trauma Score, Apache II and the Apache minus neurological weighting (Apache-NW) scores, were compared as predictors of outcome (as assessed by the Glasgow Outcome Score at 6 months). ⋯ For this group, Apache II had an outcome predictive value of 97% compared with 93% for initial and 95% for minimum GCS. Removing the neurological weighting from Apache II weakened its predictive ability in all patients, emphasizing that it is the neurological status of the patient which best predicts overall functional outcome. Apache II data are also much more time-consuming to collect than GCS data.(ABSTRACT TRUNCATED AT 250 WORDS)
-
We have reviewed the records of 53 patients with visual impairment secondary to pituitary macroadenomas and studied the visual outcome after surgery. After transsphenoidal procedures visual field defects improved in 89% of the patients and visual acuity improved in 82%. There were 13 cases of acute symptomatic intratumoural haemorrhage (pituitary apoplexy) in this series. After surgery, visual defects improved in all these cases even when the delay between the onset of symptoms and surgery was long.