Citation

Sadaka F, Jadhav A, Miller M, Saifo A, O'Brien J, Trottier S. Am. J. Emerg. Med. 2018; 36(9): 1624-1626.

Affiliation

Mercy Hospital St. Louis, St. Louis University, United States.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.ajem.2018.01.051

PMID

29433914

Abstract

INTRODUCTION: A Glasgow Coma Scale (GCS) score of 3 on presentation in patients with traumatic brain injury (TBI) portends a poor prognosis. Consequently, there is often a tendency to treat these patients less aggressively because of low expectations for a good outcome.

METHODS AND RESULTS: We performed a retrospective review of patients with TBI and a GCS score of 3. Patients were divided into 2 groups based on Glasgow Outcome Scale (GOS): Group 1 (GOS=1-3) and Group 2 (GOS=4-5). A total of 62 patients were included. The overall mortality rate was 80.6%. At 6-month, 9 patients (14.5%) achieved a GOS 4-5. Compared to Group 2 (n=9), Group 1 (n=53) had higher average APACHE IV score (104±19 vs 89±27, p=0.04), more patients with bilateral fixed pupils (59% vs 22%, p=0.04), and higher ICP burden (50±34 vs 0±0, p=0.0001). Using the CRASH calculator, the estimated mortality at 14days was 66% compared to actual mortality of 81%; difference of 15%, (p=0.05), and the estimated GOS 1-3 was 85.5% compared to actual of 85.5%, (p=1.0).

CONCLUSIONS: 14.5% of patients with TBI and a GCS of 3 at presentation achieved a good outcome at 6months, and 6.9% of patients with GCS of 3 and bilateral fixed pupils on presentation to the ED achieved a good outcome at 6months.

Copyright © 2018 Elsevier Inc. All rights reserved.

Language: en

Keywords

Coma; GCS; GOS; Glasgow coma scale; Glasgow outcome score; Outcome; TBI; Traumatic brain injury