Glasgow Coma Scale Score, Mortality, and Functional Outcome in Head-Injured Patients

✓ Of 838 patients with severe head injuries admitted since the introduction of computerized tomography, 211 (25.1%) talked at some time between trauma and subsequent deterioration into coma. Of these 211 patients, 89 (42.2%) had brain contusion/hematoma, 46 (21.8%) an epidural hematoma, 35 (16.6%) a subdural hematoma, and 41 (19.4%) did not show focal mass lesions. Thus, four of every five patients who deteriorated into coma after suffering an apparently nonsevere head injury had a mass lesion potentially requiring surgery; the mass was intracerebral in 52.3% of the cases and extracerebral in 47.6%. Patients aged 20 years or less had a 39% chance of having a nonfocal mass lesion (diffuse brain damage), a 29% chance of having an epidural hematoma, and a 32% chance of having an intradural mass lesion; patients over 40 years had only a 3% chance of having a nonfocal mass lesion, an 18% chance of having an epidural hematoma, and a 79% chance of having a intradural mass lesion. Sixty-eight (32.2%) patients died and 143 (67.8%) survived. The following were independent outcome predictors (in order of significance): Glasgow Coma Scale score following deterioration into coma, the highest intracranial pressure during the patient's course, the degree of midline shift, the type of intracranial lesion, and the age of the patient. In contrast, the mechanism of injury, the verbal Glasgow Coma Scale score during the lucid interval, and the length of time until deterioration or until operative intervention did not influence the final result.

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Faculty Opinions recommendation of Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1080943.533894 ◽

2007 ◽

Author(s):

Donald Marion

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Alcohol Intoxication ◽

Coma Scale ◽

Brain Injured ◽

Injured Patients

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Waiting for the Patient to ???Sober Up???: Effect of Alcohol Intoxication on Glasgow Coma Scale Score of Brain Injured Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000240113.13552.96 ◽

2006 ◽

Vol 61 (6) ◽

pp. 1305-1311 ◽

Cited By ~ 39

Author(s):

Jason L. Sperry ◽

Larry M. Gentilello ◽

Joseph P. Minei ◽

Ramon R. Diaz-Arrastia ◽

Randall S. Friese ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Alcohol Intoxication ◽

Coma Scale ◽

Brain Injured ◽

Injured Patients

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The Role of Immediate Operative Intervention in Severely Head-Injured Children with a Glasgow Coma Scale Score of 3

Neurosurgery ◽

10.1097/00006123-199203000-00002 ◽

1992 ◽

Vol 30 (3) ◽

pp. 320???324

Author(s):

Dennis L. Johnson ◽

Christopher Duma ◽

Carlos Sivit

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Operative Intervention ◽

Coma Scale ◽

Head Injured

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Expert-Performed Endotracheal Intubation-Related Complications in Trauma Patients: Incidence, Possible Risk Factors, and Outcomes in the Prehospital Setting and Emergency Department

Emergency Medicine International ◽

10.1155/2018/5649476 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Yuko Ono ◽

Takeyasu Kakamu ◽

Hiroaki Kikuchi ◽

Yusuke Mori ◽

Yui Watanabe ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Glasgow Coma Scale ◽

Airway Management ◽

Endotracheal Intubation ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Trauma Patients ◽

Coma Scale ◽

Injured Patients

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.

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Retroclival Epidural Hematomas

Neurosurgery ◽

10.1227/01.neu.0000372085.70895.e7 ◽

2010 ◽

Vol 67 (2) ◽

pp. 404-407 ◽

Cited By ~ 29

Author(s):

R. Shane Tubbs ◽

Christoph J. Griessenauer ◽

Todd Hankinson ◽

Curtis Rozzelle ◽

John C. Wellons ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Pediatric Patients ◽

Motor Vehicle ◽

Coma Scale ◽

Presenting Symptoms ◽

Cord Injury ◽

The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

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Epidural Hematoma

Neurotrauma ◽

10.1093/med/9780190936259.003.0005 ◽

2019 ◽

pp. 35-44

Author(s):

Lydia Kaoutzani ◽

Martina Stippler

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Epidural Hematoma ◽

Emergency Situation ◽

Intracranial Injury ◽

Coma Scale ◽

Sagittal Sinus ◽

Interosseous Artery ◽

Neurologically Intact

Although epidural hematomas (EDH) are not frequently seen with intracranial injury in trauma, they present an emergency situation that can result in significant mortality if not diagnosed and treated in a timely manner. EDH stems from bleeding from the bone rupturing an interosseous artery, the bone itself, or from a venous sinus laceration. Most EDH present with a classic biconvex shape on CT images. Venous EDH can cross the midline and are often found under the transverse or sagittal sinus. The current school of thought is that patients who present with a small (<10 mm maximal thickness) EDH with no neurological symptoms can be treated conservatively. Patients neurologically intact with a normal Glasgow Coma Scale score but an EDH of greater than 30 cc should undergo surgery.

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