@article{ref1,
title="Decision making in very severe traumatic brain injury (Glasgow Coma Scale 3-5): a literature review of acute neurosurgical management of the most severely threatened brain trauma patients",
journal="Journal of neurosurgical sciences",
year="2018",
author="van Dijck, Jeroen and Reith, Florence and van Erp, Inge and van Essen, Thomas and Maas, Andrew and Peul, Wilco C. and de Ruiter, Godard",
volume="62",
number="2",
pages="153-177",
abstract="BACKGROUND: Patients presenting with an early GCS score of 3-5 after blunt or penetrating skull-brain assaults are categorized as having sustained a very severe Traumatic Brain Injury (vs-TBI). This category is often overlooked in literature. Impact on patients and families lives however is huge and the question &quot;whether to surgically treat or not&quot; frequently poses a dilemma to treating physicians. Little is known about mortality and outcome, compared to what is known for the group of severe TBI patients (s-TBI) (GCS 3- 8). The main goal of this review is creating more awareness for the neurosurgical treatment of this patient group. <br><br>METHODS: A literature search (2000-2017) was conducted discussing 'severe TBI (GCS 3- 8)', '(neuro)surgical management' and 'outcome'. Ultimately 45 out of 2587 articles were included for further analysis. <br><br>RESULTS: Mortality rates and unfavourable outcome are high for s-TBI patients and as expected higher for vs-TBI patients. Mortality rates reach up to 100% for specific subgroups with GCS=3 and bilaterally fixed dilated pupils. Functional outcome was generally poor, but sometimes, although seldom, favourable in specific groups of vs-TBI patients after neurosurgical intervention. Factors like initial GCS, pupillary abnormalities and age seem to be associated with worse outcome. <br><br>CONCLUSIONS: Overall this literature review showed high rates of unfavourable outcome and mortality for vs-TBI patients. However, some studies, reporting relatively low mortality rates, reported &quot;good&quot; outcome for specific groups of vs-TBI patients. It is concluded that clinical decision making, in particular those on treatment limitations, should never be taken based on the GCS alone.<p /> <p>Language: en</p>",
language="en",
issn="0390-5616",
doi="10.23736/S0390-5616.17.04255-2",
url="http://dx.doi.org/10.23736/S0390-5616.17.04255-2"
}