The Prognostic Value of the Glasgow Coma Scale, Hypoxia and Computerised Tomography in Outcome Prediction of Pediatric Head Injury

Introduction. The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, “severe” patients, when scoring below the threshold and a good outcome “non severe” patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda. Methods. A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient’s demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison. Results. The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay. Conclusion. Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.

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The prognostic value of the Glasgow Coma Scale measured 24 hours after inpatient single cardiopulmonary arrest and resuscitation

Annals of Emergency Medicine ◽

10.1016/s0196-0644(89)80712-7 ◽

1989 ◽

Vol 18 (4) ◽

pp. 456-457

Author(s):

BM Thompson ◽

RM Nowak ◽

JM Hourani

Keyword(s):

Glasgow Coma Scale ◽

Prognostic Value ◽

Cardiopulmonary Arrest ◽

Coma Scale

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Tracheostomy Timing in Adult Patients with Head Injury at King Abdulaziz Medical City Hospital, Riyadh, Saudi Arabia (Cross Sectional- Retrospective Study)

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1530611 ◽

2020 ◽

pp. 68-74

Author(s):

Farhan Alenazi ◽

Prachi Dilip Tambur ◽

Noora Nabeel Mumenah ◽

Haya Hendi Alqahtani ◽

Rawan Abdulrazaq Alenazi ◽

...

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Hospital Stay ◽

P Value ◽

City Hospital ◽

Early Tracheostomy ◽

Coma Scale ◽

Icu Stay ◽

Medical City ◽

Hospital Stays

Introduction: Tracheostomy is one of the most common procedures that done to critical patients such as head injury ones to improve their situation. It is done by creating an anterior stoma in the neck and inserting a short tube to maintain stoma open. Objective: The objective of this study was to determine if there were benefits of early tracheostomy and the following components: ICU stay, hospital stay, ventilation- associated-pneumonia, weaning from Mechanical Ventilator, Glasgow Coma Scale, and decannulation. Methods: This study was done retrospectively, and non-random sampling involved 56 head injury patients with a tracheostomy who were admitted to ICU in King Abdulaziz medical city (KAMC). Out of 56 head injury patients who underwent an early tracheostomy (≤12 days) were 25 patients and late tracheotomy (>12 days) were 31 patients. Using data collection form which contains demographic data, intubation duration, tracheostomy, decannulation, MV, Glasgow coma scale, VAP, ICU, and hospital stay. Results: Total of 56 head injury patients with tracheostomy; their age ranges from 18-80 years with the mean 41.77years, height 168.95cm, and weighs 69.07kg. Head injury patient in this paper was classified according to the day that was done the procedure on after the injury occurred. Which result in 25 patients had early tracheostomy ≤12 days with a mean of (9.8 days) and median (10), whereas 31 patients had late tracheostomy >12 with mean of (17.677 days) and median (16).Patients with early tracheostomy showed significant (P-value <0.05) less length stay in ICU (22.68 days), MV duration (15.16 days), decannulation (27.80 days) compared with late trach ICU stay (33.10 days), MV duration (28.10 days), decannulation (47.03 days). VAP incidence among patients with a late trach was 12.90% and there were no VAP with an early trach. The median in early tracheostomy patients did not show any improvement in GCS (6 before trach,7 after trach) while in the late trach (7 before thrach,8 after trach). The hospital stays showed an insignificant p-value which means there were no differences between the early and late tracheostomy. Conclusion: Early tracheostomy for head injury patients associated with less MV time, less VAP, shorter ICU stay, and faster decannulation. However, there was no significant effect on hospital stays period and no improvements on GCS.

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