The Association of Glasgow Coma Scale Score With Clinically Important Traumatic Brain Injuries in Children

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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Comparison of AVPU Scale and the Glasgow Coma Scale Score in Assessing Encephalitis in Children

Pediatric Infectious Diseases Open Access ◽

10.21767/2573-0282.100029 ◽

2016 ◽

Vol 01 (04) ◽

Author(s):

Nguyen Thi Huyen Sam ◽

Pham Ngoc Toan ◽

Truong Thi Mai Hong ◽

Le Thanh Hai

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Coma Scale

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Devastating Consequences of Subway Accidents: Traumatic Amputations

The American Surgeon ◽

10.1177/000313480607200118 ◽

2006 ◽

Vol 72 (1) ◽

pp. 74-76 ◽

Cited By ~ 3

Author(s):

Alexandra A. Maclean ◽

Andrea M. O'Neill ◽

H. Leon Pachter ◽

Maurizio A. Miglietta

Keyword(s):

New York ◽

Glasgow Coma Scale ◽

Limb Salvage ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Injury Severity ◽

Vital Signs ◽

Wound Infection Rate ◽

Operative Procedures ◽

Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

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A Prehospital Glasgow Coma Scale Score ??? 14 Accurately Predicts the Need for Full Trauma Team Activation and Patient Hospitalization after Motor Vehicle Collisions

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-200209000-00018 ◽

2002 ◽

Vol 53 (3) ◽

pp. 503-507 ◽

Cited By ~ 63

Author(s):

Scott H. Norwood ◽

Clyde E. McAuley ◽

John D. Berne ◽

Van L. Vallina ◽

Robert G. Creath ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Motor Vehicle ◽

Trauma Team ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Trauma Team Activation ◽

Coma Scale

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An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia

Journal of Intensive Care ◽

10.1186/2052-0492-2-1 ◽

2014 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Atsushi Kotera ◽

Shinsuke Iwashita ◽

Hiroki Irie ◽

Junichi Taniguchi ◽

Shunji Kasaoka ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glucose Level ◽

Plasma Glucose ◽

Glasgow Coma Scale Score ◽

Plasma Glucose Level ◽

Coma Scale ◽

The Relationship

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

The American Surgeon ◽

10.1177/000313480807400319 ◽

2008 ◽

Vol 74 (3) ◽

pp. 267-270 ◽

Cited By ~ 14

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.

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

Journal of Neurosurgery ◽

10.3171/2009.10.jns09930 ◽

2010 ◽

Vol 113 (3) ◽

pp. 581-584 ◽

Cited By ~ 56

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.

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