Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Outcomes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,459 records · Page 81Linked to original sources
PubMed2005

Predicting one year clinical outcome in traumatic brain injury (TBI) at the beginning of rehabilitation.

Predicting long-term clinical outcome for patients with traumatic brain injury (TBI) at the beginning of rehabilitation provides essential information for counseling of the family and priority-setting for the limited resources in intensive rehabilitation. The objective of this study is to work out the probability of the one-year outcome at the beginning of rehabilitation. Sixty-eight patients with moderate-to-severe TBI and known one-year outcome were employed for outcome prediction using the logistic regression model. A large number of prospectively collected data at admission (age, Glasgow Coma Scale [GCS] Score, papillary response), during intensive care unit (ICU) management (duration of coma, intracranial pressure [ICP] and its progress) and at the beginning of rehabilitation (baseline Functional Independence Measure [FIM], Neuro-behavioral Cognitive Status Examination [NCSE] and Functional Movement Assessment [FMA]) were available for preliminary screening by univariate analysis. Six prognostic factors (age, GCS, duration of coma, baseline FIM, NCSC and FMA) were utilized for the final logistic regression model. Age, GCS and baseline FIM at the beginning of rehabilitation have been found to be independent predictors for one-year outcome. The accuracy of prediction for a good Glasgow Outcome Score is 68% and an outcome for disability (either moderate or severe) is 83%. Validation of this model using a new set of data is required.

Coma, Post-Head Injury↗
PubMed2005

Outcome scores in spinal surgery quantified: excellent, good, fair and poor in terms of patient-completed tools.

Outcome scores are very useful tools in the field of spinal surgery as they allow us to assess a patient's progress and the effect of various treatments. The clinical importance of a score change is not so clear. Although previous studies have looked at the minimum clinically important score change, the degree of score change varies considerably. Our study is a prospective cohort study of 193 patients undergoing discectomy, decompression and fusion procedures with minimum 2-year follow-up. We have used three standard outcome measures in common usage, the oswestry disability index (ODI), the low back outcome score (LBOS) and the visual analogue score (VAS). We have defined each of these scores according to a global measure of outcome graded by the patient as excellent, good, fair or poor. We have also graded patient perception and classified excellent and good as success and fair and poor as failure. Our results suggest that a median 24-point change in the ODI equates with a good outcome or is the minimum change needed for success. We have also found that different surgical disorders have very different minimal clinically important differences as perceived by patient perception. We found that for a discectomy a minimum 27-point change in the ODI would be classed as a success, for a decompression the change in ODI needed to class it as a success would be 16 points, whereas for a fusion the change in the ODI would be only 13 points. We believe that patient-rated global measures of outcome are of value and we have quantified them in terms of the standard outcome measures used in spinal surgery.

Decompression, Surgical↗
PubMed2007

Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?

OBJECTIVE: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. PARTICIPANTS: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. RESULTS: At admission, Hispanics were less educated (P</=.001), earned less money (P</=.05), and were younger (P</=.001) than whites. Hispanics had lower GOS-E scores (P</=.01) at acute hospital admission compared with whites. Despite similar functional status at inpatient rehabilitation discharge, Hispanic ethnicity was associated with poorer functional outcomes at 1 year postinjury (DRS, FIM, CIQ), after controlling for age, length of posttraumatic amnesia, injury severity, DRS score at admission, FIM score at admission, and preinjury educational level (P<.05). CONCLUSIONS: Hispanics showed significantly reduced long-term functional outcome after rehabilitation relative to whites. Rehabilitation professionals should recognize the possible impact of individual differences and diverse sociodemographic, injury, and rehabilitation characteristics so that differential health outcomes among TBI survivors can be reduced or eliminated.

Activities of Daily Living↗
PubMed2006

Basal and cycle androgen levels correlate with in vitro fertilization stimulation parameters but do not predict pregnancy outcome.

OBJECTIVE: To evaluate androgen levels before and during IVF. To assess for an association between androgen levels and IVF stimulation parameters or IVF pregnancy outcome. DESIGN: Prospective cohort study. SETTING: Residency-based IVF program. PATIENT(S): One hundred seventeen infertility patients. INTERVENTION(S): Androgen levels were evaluated on basal day 3 and during the IVF stimulation cycle. MAIN OUTCOME MEASURE(S): Pregnancy outcome rates and IVF stimulation parameters. RESULT(S): Mean serum androgen levels did not differ among different pregnancy outcomes. Multiple linear regression analysis revealed that body mass index (BMI) and oocyte number had a significant positive association with basal testosterone levels. Mean ovarian volume correlated negatively and follicle number correlated positively with testosterone levels on day 6 of stimulation. Peak E(2) and BMI correlated positively with testosterone on day of hCG administration. The interval change in androgen levels throughout the IVF cycle was not associated with outcome rates. Likewise, threshold analysis did not reveal any significant androgen level that affected pregnancy outcome. CONCLUSION(S): Serum androgen levels during IVF correlate with IVF stimulation parameters. However, these data do not support an influence of serum androgen levels on IVF pregnancy outcome rates.

Adult↗
PubMed2006

Relationship among hospital ERCP volume, length of stay, and technical outcomes.

BACKGROUND: The relationship between hospital procedure volume and outcome has been recognized for various specialties and procedures. Although increasingly used and in existence for 40 years, to date, data on the relationship between hospital volume and outcome of ERCP are scant. OBJECTIVE: We sought to examine health-related outcomes after ERCP in relation to hospital procedure volume. DESIGN: Secondary analysis of a national administrative database. We used the National Inpatient Sample (NIS) database to evaluate health-related outcomes among patients who underwent ERCP from 1998 to 2001. MAIN OUTCOME MEASUREMENTS: Logistic and multiple regression models were used to estimate the association of hospital ERCP volume with length of stay (LOS), rates of procedural failure, and mortality. Fixed effect models were used to adjust for all time invariant hospital characteristics for each hospital within the dataset. RESULTS: Data from 2629 hospitals that performed 199,625 ERCPs were evaluated. The median number of ERCPs performed in participating hospitals was 49 per year (range, 1-1004), with 25% of hospitals performing > or =100 ERCPs per year and 5% performing > or =200 per year. Significant trends in the relationship between volume and outcome were observed with respect to LOS and procedural failure: the median LOS was lower in high-volume (> or =200 ERCP/y) than low-volume (< or =100 ERCP/y) hospitals (6.9 vs 7.8 days, p < 0.0001) and the mean difference in expected LOS was 1.08 days (p < 0.0001). Multivariate regressions with hospital level fixed effects found significant negative relationships between procedure volume and procedure failure rates, but no significant effect on inpatient mortality rates was detected. LIMITATIONS: NIS database permits analyses of only inpatient ERCPs. It precludes analysis of procedural complications, reinterventions, and influence of individual provider volume on outcomes. CONCLUSIONS: Inpatients who undergo ERCP at high-volume hospitals have shorter LOS and lower procedural failure rates than those undergoing ERCP at low-volume hospitals. These findings have important implications for health care policy decision making and resource utilization.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2026

Postoperative complications and outcomes after surgical treatment for tophaceous gout: A systematic review and meta-analysis.

BACKGROUND: Surgical treatment remains necessary for selected patients with tophaceous gout, particularly when mechanical limitation, nerve compression, ulceration, infection, deformity, or failure of conservative treatment is present. However, postoperative outcomes after surgery for tophaceous gout have not been comprehensively quantified. This systematic review and meta-analysis evaluated postoperative complication profiles and recurrence burden after surgical treatment for tophaceous gout. METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted from database inception to March 25, 2026. Original studies reporting postoperative outcomes after surgical treatment for tophaceous gout were included. Pooled event rates with 95% confidence intervals (CIs) were calculated using a random-effects single-arm meta-analytic approach. Primary outcomes were postoperative infection, delayed wound healing, and recurrence. Secondary outcomes were reoperation, amputation, and overall complications. Functional outcomes were summarized descriptively. RESULTS: 18 retrospective studies were included. The pooled postoperative infection rate was 11.3% (95% CI 8.0%-15.7%), delayed wound healing 9.9% (95% CI 5.1%-18.2%), and recurrence 8.5% (95% CI 4.7%-14.9%). Secondary pooled rates were 9.7% (95% CI 5.5%-16.7%) for reoperation, 3.7% (95% CI 2.0%-6.8%) for amputation, and 24.0% (95% CI 14.0%-38.1%) for overall complications. Significant subgroup differences were identified only for infection according to anatomic site and intervention type. Sensitivity analyses showed that pooled estimates were robust. The certainty of evidence was very low for all outcomes. CONCLUSIONS: Surgical treatment for tophaceous gout is associated with measurable postoperative risks, particularly infection and overall complications. These findings support careful perioperative counseling, structured postoperative surveillance, integrated long-term urate-lowering management, and more standardized reporting of perioperative risk factors and postoperative outcomes in future surgical studies of tophaceous gout.

Humans↗
PubMed1996

Factors that affect outcome of in-vitro fertilisation treatment.

BACKGROUND: The effectiveness of in-vitro fertilisation (IVF) treatment depends both on the overall success rate in the treating clinic and on the characteristics of the couple seeking treatment. Since 1991, the Human Fertilisation and Embryology Authority (HFEA) has been collecting information on all IVF cycles carried out in the UK. This database has been analysed to identify the factors that affect the outcome of treatment. METHODS: All IVF treatment cycles and outcomes registered between August, 1991, and April, 1994, were identified (52507). Cycles that involved gamete or embryo donation, frozen embryo transfer, or micromanipulation and unstimulated cycles were excluded. Thus, 36961 cycles (70% of those registered) were included in the analysis. The main outcome measure was liverbirth rate per cycle started. The relation between age and outcome was investigated by fitting of different fractional polynomials of age with logistic regression models. All other factors were analysed by logistic regression with age included in the model. FINDINGS: The overall livebirth rate per cycle of treatment was 13.9%. The highest livebirth rates were in the age-group 25-30 years; younger women had lower rates and there was a sharp decline in older women. At all ages over 30, use of donor eggs was associated with a significantly higher livebirth rate than use of the woman's own eggs, but there was also a downward trend in success rate with age (p = 0.04). After adjustment for age, there was a significant decrease in livebirth rate with increasing duration of infertility from 1 to 12 years (p < 0.001). The medical indication for treatment had no significant effect on the outcome. Previous pregnancy and livebirth significantly increased treatment success. The possibility of success decreased with each IVF treatment cycle. INTERPRETATION: We were able to identify by logistic regression the factors that significantly affect the outcome of IVF treatment, and to measure the magnitude of that effect. These factors should be taken into account in assessment of IVF results. After allowance for background clinic success rates, these factors can be used to predict outcome in individual cases.

Adult↗
PubMed2000

Outcomes of renal replacement therapy among blacks and women.

The outcomes of renal replacement therapy differ dramatically by race and gender. Compared with white patients, black patients have poorer outcomes in five clinical parameters (anemia, hypertension, vascular access, adequacy of dialysis, compliance), employment, and access to transplantation. Compared with males, females have poorer outcomes in hospitalization, three clinical parameters (anemia, vascular access, nutrition), quality of life, and access to transplantation. Despite several poorer intermediate outcomes, blacks and women do better than whites and men in survival. Eliminating racial and gender differences in outcomes of renal replacement therapy requires that we (1) become aware of such differences, (2) determine barriers to optimal outcomes, and (3) develop interventions to overcome these barriers. This approach can lead to improved outcomes not just among blacks and women but among all renal patients. Examining racial and gender differences can also lead to an increased understanding of renal disease.

Adult↗
PubMed2001

Outcomes monitoring in Minnesota: treatment implications, practical limitations.

Minnesota developed its treatment outcomes monitoring system to evaluate its service delivery system and to identify specific ways to enhance treatment outcomes. Standardized patient and treatment data were collected for all outpatient and inpatient admissions, and an assessment interview and weekly treatment services records were completed for 4953 adults and 387 adolescents who consented to participate in the outcomes study. Six-month follow-up interviews were completed for 64.4% of these adults and 83.5% of these adolescents. The study identified predictors of treatment completion and outcome for adults and adolescents, and predictors of outcome by setting for adults. The study also examined results for programs designed especially for adolescents, women, and culturally specific populations, as well as the relationships to outcomes of ancillary services and continuing care activities. Anticipated policy and program design changes resulting from the findings are discussed, along with the practical limitations of conducting a state outcomes monitoring system.

Adolescent↗
PubMed1998

Prediction of outcome in neurotic disorder: a 5-year prospective study.

BACKGROUND: There have been no previous studies of the outcome of different neurotic disorders in which a prospective group with original randomization to treatment have been followed up over a long period. Such studies are important in identifying the factors associated with good and poor outcome. METHODS: A 5-year follow-up assessment was made of a cohort of 210 psychiatric out-patients seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74) or dysthymic disorder (65) and randomized to drug treatment, cognitive and behaviour therapy, and self-help. A total of 182 of the patients (87%) were assessed after 5 years by examination of hospital and GP records using a standardized procedure and outcome determined with a four-point outcome scale. RESULTS: One hundred and seven (60%) of the patients had a favourable outcome but the remainder continued to be handicapped either intermittently or continuously throughout the 5-year period. Analysis of the value of initial data in predicting outcome using polychotomous step-wise logistic regression revealed that five variables were significant predictors of poor prognosis: older age; recurrent episodes; the presence of personality disorder at entry; general neurotic syndrome at entry; and symptom severity after 10 weeks. The initial DSM diagnosis and original treatment given, together with ten other variables, were of no predictive value. CONCLUSIONS: The long-term outcome of neurotic disorder is better predicted by age, personality and recency of onset than by other clinical variables with the exception of initial response to treatment.

Adult↗
PubMed1999

Subjective outcome measurement--a primer.

There is a growing recognition within both the practice and research communities in pharmacy that serious attention must be given to the systematic study of the outcomes of pharmacy services, especially those outcomes that are focused on the patient. Research has tended to focus too strongly on the measurement of structure and process, with the unspoken assumption that if these are of good quality, the outcome will automatically be similar. However, the literature on outcome measurement instruments is vast and practitioners moving into this area for the first time may find themselves lost in a morass of conflicting definitions and different methods of measurement. This review considers the outcome measures or 'measurement instruments' that are used to assess subjective health status. Two commonly used taxonomies are described that concern the conceptual content (functional status, general health perceptions, quality of life and health-related quality of life) and the breadth of coverage of the instruments (generic, disease specific, domain or dimensions specific and patient-centred instruments). Specific attention is paid to the newest of these groups, the patient-centred instruments, which are very different in style and content to the other three and reflect a change in direction in instrument development, to address limitations of commonly used 'fixed' outcome instruments. Detail is given on what makes a quality instrument in particular circumstances (validity, reliability, sensitivity to change, multidimensional construct, practicality and applicability), to help pharmacists develop the necessary skills to select appropriate instruments in the burgeoning field of outcomes measurement.

Drug Therapy↗
PubMed2006

Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury.

To compare the effect of long-term mild hypothermia versus short-term mild hypothermia on the outcome of 215 severe traumatic brain injured patients with cerebral contusion and intracranial hypertension. At three medical centers, 215 patients aged 18 to 45 years old with an admission Glasgow Coma Scale < or =8 within 4 h after injury were randomly divided into two groups: long-term mild hypothermia group (n = 108) for 5+/-1.3 days mild hypothermia therapy and short-term mild hypothermia group (n = 107) for 2+/-0.6 days mild hypothermia therapy. All patients had intracranial hypertension and frontotemporoparietal contusion with midline shift >1 cm confirmed on computed tomographic scan. Glasgow Outcome Scale at 6-month follow-up, 47 cases had favorable outcome (43.5%), and other 61 cases had unfavorable outcome (56.5%) in the long-term mild hypothermia group. However, only 31 cases had favorable outcome (29.0%), and other 76 cases had unfavorable outcome (71.0%) in the short-term mild hypothermia group (P < 0.05). The intracranial pressure significantly rebounded after rewarming in the short-term mild hypothermia group, but not in the long-term mild hypothermia (P < 0.05). Furthermore, the incidence of stress ulcer, epilepsy, pulmonary infection, intracranial infection did not significantly differ between the two groups (P > 0.05). Compared with short-term mild hypothermia, long-term mild hypothermia significantly improves the outcome of severe traumatic brain injured patients with cerebral contusion and intracranial hypertension without significant complications. Our data suggest that 5 days of long-term cooling is more efficacious than 2 days of short-term cooling when mild hypothermia is used to control refractory intracranial hypertension in patients with severe traumatic brain injury.

Adolescent↗
PubMed2006

Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures.

An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject's functional ability to engage in activities of daily living, and (3) those that measure an individual's quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual's ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures.

Activities of Daily Living↗
PubMed2002

Patients with hip fracture: subgroups and their outcomes.

OBJECTIVES: To present several alternative approaches to describing the range and functional outcomes of patients with hip fracture. DESIGN: Prospective study with concurrent medical records data collection and patient and proxy interviews at the time of hospitalization and 6 months later. SETTING: Four hospitals in the New York metropolitan area. PARTICIPANTS: Five hundred seventy-one hospitalized adults aged 50 and older with hip fracture between July 1997 and August 1998. MEASUREMENTS: Rates of return to function in four physical domains, mortality, and nursing home residence at 6 months. Cluster analysis was used to describe the heterogeneity among the sample and identify variations in 6-month mortality, nursing home residence, and level of functioning and to develop a patient classification tree with associated patient outcomes at 6 months postfracture. RESULTS: In locomotion, transfers, and self-care, 33% to 37% of patients returned to their prior level of function by 6 months, including those needing assistance, but only 24% were independent in locomotion at 6 months. Cluster analysis identified eight patient subgroups that had distinct baseline features and variable outcomes at 6 months. The patient classification tree used four variables: atypical functional status (independent in locomotion but dependent in other domains); nursing home residence; independence/dependence in self-care; and age younger than 85 or 85 and older that identified five subgroups with variable 6-month outcomes that clinicians may use to predict likely outcomes for their patients. CONCLUSION: Patients with hip fracture are heterogeneous with respect to baseline and outcome characteristics. Clinicians may be better able to give patients and caregivers information on expected outcomes based on presenting characteristics used in the classification tree.

Activities of Daily Living↗
PubMed2005

Fetal/neonatal outcome in abruptio placentae during preterm gestation.

The purpose of this study was to evaluate the fetal/neonatal outcome and to determine the important factors in that outcome, including the use of ultrasonography and fetal heart rate monitoring, in abruptio placentae during preterm gestation. A case-control study was performed using a logistic regression model. Adverse outcome was defined as neonatal death before hospital discharge or a diagnosis of cerebral palsy in surviving neonates. Stillbirth (group 1) occurred in eight of 50 cases of abruptio placentae (16%). Adverse outcome was seen in 11 survivors (11 of 42; 26.2%). The obstetrical disseminated intravascular coagulation (DIC) score in group 1 (11.8 +/- 7.1) was higher than that in the adverse (5.7 +/- 1.3) and satisfactory (5.3 +/- 2.4) outcome groups. A low Apgar score (< 7) at 5 minutes (odds ratio, 19.8; 95% confidence interval, 2.0 to 197.8) was associated with increased risk of adverse outcome in the logistic regression model. Although the obstetrical DIC score was high and may reflect the severity of maternal complications in the stillbirth group, there were no typical ultrasonographic findings and fetal heart rate patterns in abruptio placentae during preterm gestation predicting adverse outcome among survivors.

Adult↗
PubMed2002

Neuropsychological assessment and employment outcome after traumatic brain injury: a review.

While there may be many reasons for obtaining neuropsychological assessment after traumatic brain injury (TBI), prediction of real world functioning is generally a key goal. The present paper reviews 23 studies concerning the relationship between neuropsychological test results and employment outcome after TBI. The review was conducted in accordance with guidelines developed by the Committee on Empirically Supported Practice of Division 40 (Neuropsychology) of the American Psychological Association. Results of the review support a Category A (strongly supported) recommendation for the use of early neuropsychological assessment to predict late employment outcome. Studies of late neuropsychological assessment and subsequent employment outcome and studies of concurrent neuropsychological assessment and employment outcome were inconclusive regarding either support or contraindication for neuropsychological assessment to predict employment outcome. Almost all studies conducted at these late or concurrent time points had significant limitations with regard to study type or adequacy of methodology. However, there is no conceptual basis for believing that neuropsychological findings obtained closer in time to assessment of employment outcome should be less predictive of this outcome than neuropsychological findings obtained at an earlier time.

Brain Injuries↗
PubMed2006

Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004.

BACKGROUND: Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. METHODS: We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. RESULTS: Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. CONCLUSIONS: Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.

Adult↗
PubMed2002

Outcome of traumatic brain injuries in 1,508 patients: impact of prehospital care.

This article describes the outcome of 1,508 patients with traumatic brain injuries (TBI) treated in a single neurosurgical unit over an 8-year period. Our aim has been to compare those outcomes with our previous results and with other large patient series. Another important goal was to evaluate the effect of the introduction of a 4-year ongoing study initiated in January 1993 using a new strategy of prehospital care on postresuscitation Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS). Results from the 1,508 patients showed good recovery or moderate disability in 69%, severe disability or vegetative state in 11%, and a mortality rate of 20%. When outcome of the most severely injured patients (GCS < or = 8) was compared with those of our previous and other large international patient series, more favorable outcome figures were shown in the present study. To evaluate the impact of the improved prehospital care after half of the study period, a logistic regression analysis showed after January 1993 a significantly increased expected odds/ratio for a postresuscitation GCS 8-15 rather than a GCS 3-4 (odds/ratio: 2.2; p < 0.001). For patients with postresuscitation GCS 5-7 and 8-15, the expected odds/ratio for a GOS 4-5 instead of GOS 1 increased significantly (odds/ratio: 2.2 and 1.7, respectively; p < 0.05-0.01). For patients with GCS 3-4, an increased expected odds/ratio (2.0; p < 0.05) for a GOS 2-3 rather than a GOS 1 was seen. The principal conclusion is that outcome for the severely injured patients in the present study is more favorable than in other large series of TBI. We posit that the introduction of effective prehospital care most likely contributed to the improved postresuscitation neurological status and consequently to the better outcome observed after January 1993.

Adult↗