Mortality by Decade in Trauma Patients with Glasgow Coma Scale 3

2011 ◽  
Vol 77 (10) ◽  
pp. 1342-1345 ◽  
Author(s):  
Eric J. Ley ◽  
Morgan A. Clond ◽  
Omar N. Hussain ◽  
Marissa Srour ◽  
James Mirocha ◽  
...  
Keyword(s):  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Trauma System ◽  
Mortality Rates ◽  
High Survival ◽  
Trauma Patients ◽  
Coma Scale ◽  
The Third ◽  
Aggressive Care ◽  
Improvement In Survival

The aim of this study was to assess how increasing age affects mortality in trauma patients with Glasgow Coma Scale (GCS) 3. The Los Angeles County Trauma System Database was queried for all patients aged 20 to 99 years admitted with GCS 3. Mortality was 41.8 per cent for the 3306 GCS 3 patients. Mortality in the youngest patients reviewed, those in the third decade, was 43.5 per cent. After logistic regression analysis, patients in the third decade had similar mortality rates to patients in the sixth (adjusted OR, 0.88; CI, 0.68 to 1.14; P = 0.33) and seventh decades (adjusted OR, 0.96; CI, 0.70 to 1.31; P = 0.79). A significantly lower mortality rate, however, was noted in the fifth decade (adjusted OR, 0.76; CI, 0.61 to 0.95; P = 0.02). Conversely, significantly higher mortality rates were noted in the eighth (adjusted OR, 1.93; CI, 1.38 to 2.71; P = 0.0001) and combined ninth/tenth decades (adjusted OR, 2.47; CI, 1.71 to 3.57; P < 0.0001). Given the high survival in trauma patients with GCS 3 as well as continued improvement in survival compared with historical controls, aggressive care is indicated for patients who present to the emergency department with GCS 3.

Abstract TP235: Deterioration and Improvement in the Field: Comparative Detection by Los Angeles Motor Scale and Glasgow Coma Scale in Acute, EMS-transported Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anita Tipirneni ◽  
Kristina Shkirkova ◽  
Nerses Sanossian ◽  
Sidney Starkman ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Intracranial Hemorrhage ◽  
Stroke Patients ◽  
Coma Scale ◽  
Acute Cerebral Ischemia ◽  
Stroke Evolution ◽  
Global Impression Of Change ◽  
Los Angeles Motor Scale

Background: Stroke evolution after hospital arrival is well characterized for acute cerebral ischemia and intracranial hemorrhage. But with the advent of patient routing to designated stroke centers, and of prehospital stroke therapeutic trials, it is important to characterize stroke evolution in the earliest, prehospital moments of onset. Initial studies have prehospital evolution using serial Glasgow Coma Scale (GCS) assessment; however, GCS assesses level of consciousness rather than focal deficits. Methods: In the NIH FAST-MAG trial database, we analyzed patient deficit evolution from time of first paramedic assessment to early post-arrival assessment in the ED, using serial scores on the GCS, serial scores on the Los Angeles Motor Scale (LAMS) (a prehospital stroke deficit measure), and the Paramedic Global Impression of Change (PGIC) score, a 5 point Likert paramedic-clinician score. Results: Among 1632 acute, EMS-transported neurovascular disease patients, 1,245 (76.3%) had a final diagnosis of acute cerebral ischemia and 387 (23.7%) of acute intracranial hemorrhage. Time of paramedic initial assessment was median 23 mins (IQR 14-41) after onset and time of early ED assessment 58 mins (IQR 46-78). Considering score changes by 2 or more as salient, overall the LAMS and GCS indicated approximately equal frequencies of prehospital deterioration (LAMS 11.1%, GCS 12.0%), but the LAMS indicated higher frequencies of prehospital improvement (LAMS 24.5% vs GCS 5.7%, p<0.001), due to the ceiling constraint of the GCS. The LAMS correlated more strongly than the GCS with the paramedic global impression of change among all patients, r=0.31 vs 0.19, and especially in acute cerebral ischemia patients, r=0.27 vs 0.08). The prehospital course differed by stroke subtype on the LAMS: acute cerebral ischemia: improved 30.7%, worsened 7.1%, stable 62.25%; intracranial hemorrhage: improved 4.5%, worsened 24.2%, stable 71.3%. Conclusions: Focal deficit scales are superior to the GCS in characterizing prehospital stroke evolution. Change in neurologic status occurs in more than one-third of acute stroke patients during transport and the early ED, with improvement more common in acute cerebral ischemia and deterioration more common in ICH.

Abstract WP330: Refining Prehospital Stroke Severity Measures: Is There Added Benefit to Combining Field Glasgow Coma Scale and Los Angeles Motor Score?

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Shauna Cheung ◽  
Kristina Shkirkova ◽  
David Liebeskind ◽  
Mark Sabra ◽  
Sidney Starkman ◽  
...  
Keyword(s):  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Stroke Severity ◽  
Motor Score ◽  
Coma Scale ◽  
Added Benefit

Overnight Intubation in Glasgow Coma Scale Depressed Trauma Patients: Are We Helping or Harming?

2018 ◽  
Vol 227 (4) ◽  
pp. e239
Author(s):  
Amory C. de Roulet ◽  
Ilan I. Maizlin ◽  
Ricardo A. Jacquez ◽  
Mary Ellen Zimmerman ◽  
Michael Coomaraswamy ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Trauma Patients ◽  
Coma Scale

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

Trauma patients with prehospital Glasgow Coma Scale less than nine: not a homogenous group

2019 ◽  
Vol 46 (4) ◽  
pp. 873-878 ◽  
Author(s):  
Cino Bendinelli ◽  
Dominic Ku ◽  
Kate Louise King ◽  
Shane Nebauer ◽  
Zsolt Janos Balogh
Keyword(s):  
Glasgow Coma Scale ◽  
Trauma Patients ◽  
Coma Scale ◽  
Homogenous Group
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