A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

2021 ◽  
Author(s):  
Gerard Hageman ◽  
Jik Nihom
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
English Language ◽  
Abusive Head Trauma ◽  
High Energy ◽  
Coma Scale ◽  
Moderate Traumatic Brain Injury

Abstract Objective The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12. Data Source We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020. Study Selection We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI. Data Synthesis Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9–16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower. Conclusion We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.

Blast Injury in a Civilian Trauma Setting is Associated with a Delay in Diagnosis of Traumatic Brain Injury

2008 ◽  
Vol 74 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Grant V. Bochicchio ◽  
Kimberly Lumpkins ◽  
James O'Connor ◽  
Marc Simard ◽  
Stacey Schaub ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Disease Process ◽  
Blast Injury ◽  
Coma Scale ◽  
The Mean

High-pressure waves (blast) account for the majority of combat injuries and are becoming increasingly common in terrorist attacks. To our knowledge, there are no data evaluating the epidemiology of blast injury in a domestic nonterrorist setting. Data were analyzed retrospectively on patients admitted with any type of blast injury over a 10-year period at a busy urban trauma center. Injuries were classified by etiology of explosion and anatomical location. Eighty-nine cases of blast injury were identified in 57,392 patients (0.2%) treated over the study period. The majority of patients were male (78%) with a mean age of 40 ± 17 years. The mean Injury Severity Score was 13 ± 11 with an admission Trauma and Injury Severity Score of 0.9 ± 0.2 and Revised Trauma Score of 7.5 ± 0.8. The mean intensive care unit and hospital length of stay was 2 ± 7 days and 4.6 ± 10 days, respectively, with an overall mortality rate of 4.5 per cent. Private dwelling explosion [n = 31 (35%)] was the most common etiology followed by industrial pressure blast [n = 20 (22%)], industrial gas explosion [n = 16 (18%)], military training-related explosion [n = 15 (17%)], home explosive device [n = 8 (9%)], and fireworks explosion [n = 1 (1%)]. Maxillofacial injuries were the most common injury (n = 78) followed by upper extremity orthopedic (n = 29), head injury (n = 32), abdominal (n = 30), lower extremity orthopedic (n = 29), and thoracic (n = 19). The majority of patients with head injury [28 of 32 (88%)] presented with a Glasgow Coma Scale score of 15. CT scans on admission were initially positive for brain injury in 14 of 28 patients (50%). Seven patients (25%) who did not have a CT scan on admission had a CT performed later in their hospital course as a result of mental status change and were positive for traumatic brain injury (TBI). Three patients (11%) had a negative admission CT with a subsequently positive CT for TBI over the next 48 hours. The remaining four patients (14%) were diagnosed with skull fractures. All patients (n = 4) with an admission Glasgow Coma Scale score of less than 8 died from diffuse axonal injury. Blast injury is a complicated disease process, which may evolve over time, particularly with TBI. The missed injury rate for TBI in patients with a Glasgow Coma Scale score of 15 was 36 per cent. More studies are needed in the area of blast injury to better understand this disease process.

Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults

2010 ◽  
Vol 113 (3) ◽  
pp. 581-584 ◽  
Author(s):  
David Krahulik ◽  
Jirina Zapletalova ◽  
Zdenek Frysak ◽  
Miroslav Vaverka
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Clinical Symptoms ◽  
Empty Sella ◽  
Pituitary Hormone ◽  
Endocrine Dysfunction ◽  
Coma Scale

Object Traumatic brain injury (TBI) is a major cause of serious morbidity and mortality. The incidence is 100–500/100,000 inhabitants/year. Chronic pituitary dysfunction is increasingly recognized after TBI. To define the incidence of endocrine dysfunction and risk factors, the authors describe a prospectively assessed group of patients in whom they documented hormonal functions, early diagnosis, and treatment of neuroendocrine dysfunction after TBI. Methods Patients aged 18–65 years were prospectively observed from the time of injury to 1 year postinjury; the Glasgow Coma Scale score ranged from 3 to 14. Patients underwent evaluation of hormonal function at the time of injury and at 3, 6, and 12 months postinjury. Magnetic resonance imaging was also conducted at 1 year postinjury. Results During the study period, 89 patients were observed. The mean age of the patients was 36 years, there were 23 women, and the median Glasgow Coma Scale score was 7. Nineteen patients (21%) had primary hormonal dysfunction. Major deficits included growth hormone dysfunction, hypogonadism, and diabetes insipidus. Patients in whom the deficiency was major had a worse Glasgow Outcome Scale score, and MR imaging demonstrated empty sella syndrome more often than in patients without a deficit. Conclusions To the authors' knowledge, this is the third largest study of its kind worldwide. The incidence of chronic hypopituitarism after TBI was higher than the authors expected. After TBI, patients are usually observed on the neurological and rehabilitative wards, and endocrine dysfunction can be overlooked. This dysfunction can be life threatening and other clinical symptoms can worsen the neurological deficit, extend the duration of physiotherapy, and lead to mental illness. The authors recommend routine pituitary hormone testing after moderate or severe TBI within 6 months and 1 year of injury.

scholarly journals Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54,069 patients with traumatic brain injury

Injury ◽  
2017 ◽  
Vol 48 (9) ◽  
pp. 1932-1943 ◽  
Author(s):  
Florence C.M. Reith ◽  
Hester F. Lingsma ◽  
Belinda J. Gabbe ◽  
Fiona E. Lecky ◽  
Ian Roberts ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale ◽  
Differential Effects

Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention

JAMA Surgery ◽  
2016 ◽  
Vol 151 (10) ◽  
pp. 954 ◽  
Author(s):  
Itamar Ashkenazi ◽  
William P. Schecter ◽  
Kobi Peleg ◽  
Adi Givon ◽  
Oded Olsha ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale ◽  
Neurosurgical Intervention

scholarly journals Effect of Electroacupuncture at Auricular Acupoints “Heart” and “Brainstem” in Improving the Consciousness of Patients after Traumatic Brain Injury: Study Protocol for a Randomized Controlled Trial

2019 ◽  
Author(s):  
Tong Liu ◽  
Jia-Ni Yu ◽  
Wei-chuan Kuang ◽  
Xiao-yin Wang ◽  
Ye Jiang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Mismatch Negativity ◽  
Auricular Acupuncture ◽  
Efficacy And Safety ◽  
Coma Scale ◽  
Body Acupuncture

Abstract Background:Traumatic brain injury (TBI) has become a major cause of morbidity and mortality both in China and abroad. Disorders of consciousness (DOC) following severe traumatic brain injury (TBI) is a common refractory complication, resulting in difficult rehabilitation and poor life quality. However, effective therapeutic approaches remain limited. Although auricular-acupuncture has been widely applied in the treatment of neurological disorders in China, its efficacy and safety for consciousness recovery remain to be elucidated. Methods: Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of Electroacupuncture at Auricular Acupoints “Heart” and “Brainstem” in the consciousness recovery of patients with TBI. A total of 80 patients with initial Glasgow coma scale score between 3-8 points will be recruited in the trial and randomized into treatment (combined application of auricular and body acupuncture) group or control (body acupuncture alone) group. Patients in the treatment group will receive electroacupuncture at bilateral auricular acupoints “Heart” and “Brainstem” (four points in total) combined with body acupuncture in a supine position while patients in the control group will receive body acupuncture alone for 4 weeks. The primary outcomes are changes of Glasgow coma scale score and mismatch negativity of event-related brain potentials before and after treatment. The secondary outcome measures will be changes of Barthel and FuglMeyer scores. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. Discussion: Results from this trial will significantly support the application of auricular acupuncture in the consciousness recovery of patients with severe TBI. If found to be effective and safe, auricular acupuncture will be a valuable complementary option for comatose patients with TBI. Trial registration: Chinese Clinical Trial Registry: ChiCTR1800020245. Registered on 21 December 2018. Keywords: Auricular acupoint, Electro-acupuncture, Body acupuncture, Traumatic brain injury, Consciousness, GCS, Mismatch negativity

736: IMPACT OF GLASGOW COMA SCALE SCORE ON MORTALITY IN PEDIATRIC SEVERE TRAUMATIC BRAIN INJURY

2016 ◽  
Vol 44 (12) ◽  
pp. 260-260
Author(s):  
Sarah Murphy ◽  
Neal Thomas ◽  
Shira Gertz ◽  
John Beca ◽  
Michael Bell ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Glasgow Coma Scale Score ◽  
Coma Scale

scholarly journals Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients

2017 ◽  
Vol 2 ◽  
pp. 85-93 ◽  
Author(s):  
John K. Yue ◽  
Caitlin K. Robinson ◽  
Ethan A. Winkler ◽  
Pavan S. Upadhyayula ◽  
John F. Burke ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale
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