Neurosurgical intervention was required in 16.5% of the patients, which the investigators indicated was associated with favorable outcome. “In particular, in Marshall category V, the prevalence of unfavorable outcome dropped to nearly 20% following neurosurgical intervention, confirming the importance of mass lesion evacuation in these cases,” they stated.
Of the 18 variables considered, six were independently associated with unfavorable outcome at six months: basal skull fracture, subarachnoid hemorrhage, coagulopathy, subdural hematoma, modified Marshall category, and GCS. “This combination of variables predicts the six-month outcome with high sensitivity (95.6%) and specificity (86%),” said the authors. They noted that although coagulopathy was the third strongest predictor of unfavorable outcome in the model, after GCS and Marshall category, the exclusion of coagulopathy did not significantly impair the sensitivity for outcome prediction.
Fabbri A, Servadei F, Marchesini G, et al. Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry. 2008;79(5):567-573.
Coffee and Tea Drinkers May Have Increased Protection From Cerebral Infarction
Men who drink eight or more cups of coffee or two or more cups of tea per day may have a significantly decreased stroke risk than men whose daily consumption is less than that, according to a study published in the March 27 online Stroke. The effect was independent of known cardiovascular risk factors, added Susanna C. Larsson, PhD, from the Division of Nutritional Epidemiology at the Karolinska Institute in Stockholm, and colleagues.
Data on the participants—26,556 Finnish men ages 50 to 69—were collected prospectively as part of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. All were smokers (five or more cigarettes per day) with no history of stroke at baseline. About 2.5% of the cohort reported that they never drank coffee, and 64% said that they never drank tea.
During the mean 13.6 years of follow-up, there were 2,702 cerebral infarctions, 383 intracerebral hemorrhages, 196 subarachnoid hemorrhages, and 84 unspecified strokes. “After adjustment for age, supplementation group, and cardiovascular risk factors, both coffee consumption and tea consumption were statistically significantly inversely associated with risk of cerebral infarction but not of intracerebral or subarachnoid hemorrhage,” the authors said. The relative risk (RR) of cerebral infarction for the men who drank the most coffee (eight or more cups per day) compared with those who drank the least (less than two cups per day) was 0.77, and the relationship was mediated in a dose-response fashion. High consumption of tea (two or more cups per day) also protected against cerebral infarction (RR compared with nondrinkers, 0.79).
“Caffeine intake also showed an inverse association with cerebral infarction,” stated Dr. Larsson and colleagues (RR for median of 880 vs 189 mg/day, 0.76). However, because a previous study had found that supplementation of the dietary antioxidant α-tocopherol had also decreased a patient’s risk of cerebral infarction, the researchers added that “this association may reflect the correlation between caffeine intake and other potentially protective factors in coffee and tea rather than a direct association between caffeine and cerebral infarction.”
Larsson SC, Männistö S, Virtanen MJ, et al. Coffee and tea consumption and risk of stroke subtypes in male smokers. Stroke. 2008 Mar 27; [Epub ahead of print].