Head-injured adult patients with GCS of 3 on admission ? Who have a chance to survive?

Kotwica, Z; Jakubowski, J. K.

doi:10.1007/bf01404948

Cited by 38 publications

(19 citation statements)

References 24 publications

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“…Patients presenting with low postresuscitation GCS scores have extremely high morbidity and mortality rates. 14,18,29,50 Predictive variables for survival…”

Section: Discussionmentioning

confidence: 99%

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Fulkerson

White

Rees

et al. 2015

PED

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OBJECT Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. METHODS A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a “normal” outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. RESULTS Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical, historical, and radiological factors were analyzed for correlation with survival and clinical outcome. Classification trees were formed to stratify predictive factors. The pupillary response was the factor most predictive of both survival and outcome. Other factors that either positively or negatively correlated with survival included hypothermia, mechanism of injury (abuse), hypotension, major concurrent symptoms, and midline shift on CT scan. Other factors that either positively or negatively predicted long-term outcome included hypothermia, mechanism of injury, and the assessment of the fontanelle. CONCLUSIONS In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more years. Factors that correlated with survival and outcome included the pupillary response, hypothermia, and mechanism. The authors discuss factors that may help surgeons make critical decisions regarding their most serious pediatric trauma patients.

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“…Patients presenting with low postresuscitation GCS scores have extremely high morbidity and mortality rates. 14,18,29,50 Predictive variables for survival…”

Section: Discussionmentioning

confidence: 99%

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Fulkerson

White

Rees

et al. 2015

PED

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“…14 Increased severity of TBI (i.e. moderate to severe) has been associated with higher mortality due to seizures, septicemia, pneumonia, and respiratory conditions.…”

Section: Introductionmentioning

confidence: 99%

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Greenwald

Hammond

Harrison-Felix

et al. 2015

Journal of Neurotrauma

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Severe traumatic brain injury (TBI) has been associated with increased mortality. This study characterizes long-term mortality, life expectancy, causes of death and risk factors for death among patients admitted within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS) who lack command following at the time of admission for inpatient TBI rehabilitation. Of the 8,084persons enrolled from 1988 and 2009, 387 from 20 centers met study criteria.Individuals with moderate to severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the U.S. general population of similar age, gender and race, with an average life expectancy (LE) reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation were 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the US general population matched for age, gender and race/ethnicity, these non-command following individuals were over 4 times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared to the US general population, and compared to all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate compared to the general population.

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“…Encouraging therapeutical strategies against secondary brain injury has been investigated in clinical trials 2,10 . However, currently, there is no treatment able to block secondary brain injury and the delayed cerebral atrophy.…”

Section: Discussionmentioning

confidence: 99%

Bilateral cortical atrophy after severe brain trauma and extradural homatoma

Louzada

Vaitsman

Souza

et al. 2007

Arq. Neuro-Psiquiatr.

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-We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.KEY WORDS: brain atrophy, extradural hematoma, epidural hematoma, severe head injury, secondary injury. Atrofia cortical bilateral após traumatismo cranioencefálico grave e hematoma extraduralRESUMO -Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões. PALAVRAS-CHAVE: atrofia cerebral, hematoma extradural, hematoma epidural, traumatismo craniano grave, injúria secundária.

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Head-injured adult patients with GCS of 3 on admission ? Who have a chance to survive?

Cited by 38 publications

References 24 publications

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Bilateral cortical atrophy after severe brain trauma and extradural homatoma

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