Coup and contrecoup head injuries: Predictors of outcome

Coup and contrecoup contusions comprise a group of focal brain injuries. The pathogenesis of the two are different, the outcome in the two would therefore be expected to be different. However there are no studies in literature comparing outcome in coup-contrecoup injuries. At NIMHANS, Bangalore, two hundred and ninety eight consecutive cases presenting with coup and contrecoup injuries over a 2-year period were retrospectively analyzed. They were divided into three groups: Coup injuries with intraparenchymal injury (n = 129), contrecoup injuries (n = 84) and coup-contrecoup injuries (n = 85). The groups were comparable with respect to age and GCS. Site of primary impact was determined by clinical and CT scan criteria. The mortality rates in each group were compared with respect to age, GCS and CT pattern. Significance was calculated using the chi-square test. There was a statistically significant difference in mortality between patients with coup injuries and patients with contrecoup (p < 0.005) and coup-contrecoup injuries (p<0.001). There was no significant difference in mortality between contrecoup and coup-contrecoup injuries (p = 0.1). Mortality in patients aged less that 60 years and patients with GCS > 8 was significantly higher in patients with contrecoup and coup-contrecoup injuries. Presence of a contrecoup component on CT scan may portend a worse outcome in head injuries and may warrant closer monitoring and more aggressive management of these patients.