Using the Abbreviated Injury Severity and Glasgow Coma Scale Scores to Predict 2-Week Mortality After Traumatic Brain Injury

2011 ◽  
Vol 71 (5) ◽  
pp. 1172-1178 ◽  
Author(s):  
Shelly D. Timmons ◽  
Tiffany Bee ◽  
Sharon Webb ◽  
Ramon R. Diaz-Arrastia ◽  
Dale Hesdorffer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Coma Scale ◽  
Scale Scores

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.

Detection of neurofilament-H in serum as a diagnostic tool to predict injury severity in patients who have suffered mild traumatic brain injury

2014 ◽  
Vol 121 (5) ◽  
pp. 1232-1238 ◽  
Author(s):  
Joshua W. Gatson ◽  
Jennifer Barillas ◽  
Linda S. Hynan ◽  
Ramon Diaz-Arrastia ◽  
Steven E. Wolf ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Clinical Findings ◽  
Ct Scans ◽  
Healthy Controls ◽  
Scale Scores

Object In previous studies of traumatic brain injury (TBI), neural biomarkers of injury correlate with injury severity and predict neurological outcome. The object of this paper was to characterize neurofilament-H (NFL-H) as a predictor of injury severity in patients who have suffered mild TBI (mTBI). Thus, the authors hypothesized that phosphorylated NFL-H (pNFL-H) levels are higher in mTBI patients than in healthy controls and identify which subjects experienced a more severe injury such as skull fractures, intracranial hemorrhaging, and/or contusions as detected by CT scans. Methods In this prospective clinical study, blood (8 ml) was collected from subjects (n = 34) suffering from mTBI (as defined by the American Congress of Rehabilitation and Glasgow Coma Scale scores between 13 and 15) at Parkland Hospital, Dallas, Texas, on Days 1 and 3 after injury). Additional clinical findings from the CT scans were also used to categorize the TBI patients into those with and those without clinical findings on the scans (CT+ and CTgroups, respectively). The serum levels of pNFL-H were measured using the enzyme-linked immunosorbent assay. Results Compared with healthy controls, the mTBI patients exhibited a significant increase in the serum levels of pNFL-H on Days 1 (p = 0.00001) and 3 (p = 0.0001) after TBI. An inverse correlation was observed between pNFL-H serum levels and Glasgow Coma Scale scores, which was significant. Additionally, using receiver operating characteristic curve analysis to compare the mTBI cases with controls to determine sensitivity and specificity, an area under the curve of 100% was achieved for both (p = 0.0001 for both). pNFL-H serum levels were only significantly higher on Day 1 in mTBI patients in the CT+ group (p < 0.008) compared with the CT− group. The area under the curve (82.5%) for the CT+ group versus the CT− group was significant (p = 0.021) with a sensitivity of 87.5% and a specificity of 70%, using a cutoff of 1071 pg/ml of pNFL-H in serum. Conclusions This study describes the serum profile of pNFL-H in patients suffering from mTBI with and without CT findings on Days 1 and 3 after injury. These results suggest that detection of pNFL-H may be useful in determining which individuals require CT imaging to assess the severity of their injury.

Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old

2010 ◽  
Vol 27 (9) ◽  
pp. 1549-1555 ◽  
Author(s):  
Alexandra Brazinova ◽  
Walter Mauritz ◽  
Johannes Leitgeb ◽  
Ingrid Wilbacher ◽  
Marek Majdan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Coma Scale ◽  
Scale Scores

Serum ferritin correlates with Glasgow coma scale scores and fatal outcome after severe traumatic brain injury

Brain Injury ◽  
2015 ◽  
Vol 29 (5) ◽  
pp. 612-617 ◽  
Author(s):  
Daniel Simon ◽  
Josi Mara Botome Nicol ◽  
Sabrina Sabino da Silva ◽  
Camila Graziottin ◽  
Patrícia Corso Silveira ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Serum Ferritin ◽  
Severe Traumatic Brain Injury ◽  
Fatal Outcome ◽  
Coma Scale ◽  
Scale Scores

scholarly journals Pediatric Firearm-Related Traumatic Brain Injury in United States Trauma Centers

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hansen Deng ◽  
John K Yue ◽  
Ethan A Winkler ◽  
Sanjay S Dhall ◽  
Geoffrey T Manley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Trauma Centers ◽  
Lower Odds ◽  
Coma Scale ◽  
Level Ii ◽  
Suicide Intent ◽  
Overall Mortality

Abstract INTRODUCTION Firearm injury is a leading cause of death and disability in the American youth. Epidemiology and outcomes following gunshot wound to the head (GSWH) are in need of systematic characterization. Here, we analyzed pediatric GSWH to identify predictors of prolonged hospitalization, morbidity and mortality. METHODS All patients < 18 yr with GSWH in the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) from 2003 to 2012 were identified. Variables included injury intent, firearm choice, injury site, age, sex, race, health insurance, geographic region, trauma center level, isolated TBI, emergency department (ED) hypotension, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). Outcomes were hospital length of stay (HLOS), morbidity and mortality. Odds ratios (OR), mean increase/decrease (B), and 95% confidence intervals (CI) were reported. Statistical significance was assessed at a < 0.001 accounting for multiple comparisons. RESULTS In a weighted sample of 2847 pediatric GSWHs, age was 14.8 ± 3.3 yr, 79.2% were male, and 59.0% had severe traumatic brain injury (TBI; Glasgow Coma Scale [GCS] score 3-8). Assault (63.0%), handgun as firearm (45.6%), and injury in residential areas (40.6%) were most common. HLOS was 11.6 ± 14.4 d for the survivors, for which suicide injuries had longer hospitalization (B = 5.9 day increase, 95% CI [3.3-8.6], P < .001) relative to accidents. The overall mortality was 45.1%, and was greater with suicide intent (mortality = 71.5%, P < .001) and shotgun as firearm (mortality = 56.5%, P < .001). Lower GCS, higher ISS, and hypotension predicted poorer outcomes. Management at level II centers was associated with lower odds of returning home (OR = 0.3, [0.2-0.5], P < .001). CONCLUSION From 2003 to 2012, the proportion of accidental injuries decreased while suicides increased. The overall mortality was 45%, with hypotension, cranial and overall injury severity, and suicide intent being associated with poor prognosis. Patients treated at level II trauma centers had lower odds of being discharged home. Improved risk screening, parental education and standardization of critical care management are needed.

Sign in / Sign up

Export Citation Format

Share Document