Relationship of The Degree of Head Injury Based on Glasgow Coma Scale (GCS) with the Arrival of Acute Post Concussion Syndrome (PCS) Onset in Post-Head Injury Patients in General Hospital Dr.M.Djamil Padang

A B S T R A C TBackground: Traumatic brain injury is the main cause of death in the populationunder the age of 45 years, and the fourth leading cause of death in the entire ofpopulation. Based on the degree of traumatic brain injury, it is commonly categorizedbased on the Glasgow Coma Scale (GCS). Post-Concussion Syndrome (PCS) is theset of somatic, emotional / behavioral and cognitive symptoms that occur after atraumatic brain injury. The aim of this study was to find out the prevalence andcorrelation of the degree of traumatic brain injury based on the Glasgow Coma Scale(GCS) and the emersion of Post-Concussion Syndrome (PCS) acute onset in patientswith head injuries Method: This study was a cross-sectional analytic study ofpatients who experienced Post-Concussion Syndrome (PCS) after traumatic braininjury at DR. M. Djamil Hospital Padang in 2020 from June to November 2020. Datawere collected by filling in a questionnaire (The Rivermead Post ConcussionSymptoms Questionnaire) and medical record data of neurosurgical patients thatmet the inclusion and exclusion criteria. Result: : It indicated that 70 patients wereincluded in the inclusion criteria of this study. A total of 38 (54.3) respondents didnot undergo the acute onset of PCS, meanwhile respondents who experienced acuteonset of PCS were 32 (45.7) respondents. The results showed that 25 (67.6%)respondents with mild traumatic brain injury had PCS acute onset, while 4 (17.4%)respondents with moderate degree of traumatic brain injury had PCS acute onset,and 4 (17.4%) respondents had PCS acute onset PCS 3 (30%) respondentsexperienced severe traumatic brain injury with acute onset PCS and statistically thedifference in the proportion of data from each of these variables was significant witha p-value of 0.0001. The results of statistical tests showed that p value> 0.05 on thecorrelation between PCS and GCS, thus, it can be concluded that there was nocorrelation between the direction of the relationship between PCS and GCS.Conclusion There was no correlation between the degree of traumatic brain injurybased on GCS and the incidence of PCS acute onset, either it was unidirectional orvice versa in patients with head injuries at RSUP M. Djamil Padang.

Download Full-text

Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

Emergency Medicine Journal ◽

10.1136/emermed-2018-208154 ◽

2020 ◽

Vol 37 (3) ◽

pp. 127-134 ◽

Cited By ~ 2

Author(s):

Amit Kochar ◽

Meredith L Borland ◽

Natalie Phillips ◽

Sarah Dalton ◽

John Alexander Cheek ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Glasgow Coma Scale ◽

Decision Rules ◽

Secondary Analysis ◽

Clinical Decision ◽

Important Indicator ◽

Coma Scale ◽

Gcs Score

ObjectiveHead injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.MethodsPlanned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.ResultsOf 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).ConclusionsOutside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.

Download Full-text

Correlation of Glasgow Coma Scale with Non-Contrast Computed Tomography findings in immediate post traumatic brain injury

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191077 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1059

Author(s):

Basudev Agrawal ◽

Rupesh Verma

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Glasgow Coma Scale ◽

Ct Scan ◽

Age Group ◽

Female Ratio ◽

Coma Scale ◽

Gcs Score

Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.

Download Full-text

Surgical management of head injury

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0043 ◽

2019 ◽

pp. 509-520

Author(s):

Hadie Adams ◽

Angelos G. Kolias ◽

Adel Helmy ◽

Peter J.A. Hutchinson ◽

Randall M. Chesnut

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Young Adult ◽

Head Injury ◽

Glasgow Coma Scale ◽

Motor Vehicle ◽

Adult Males ◽

Coma Scale ◽

The United Kingdom ◽

The World

Traumatic brain injury (TBI) is a significant cause of preventable morbidity and mortality in the United Kingdom and across the world, leading to disability and loss of productivity. The estimated incidence of TBI in Europe is on average 235 per 100 000, ranging of 150–300/100 000 per year. The Glasgow Coma Scale (GCS) is often used to classify the severity of TBI, with patients scoring 8 or less being classified as severe, 9–12 as moderate, and scores of 13–15 as mild. Mild TBI is the most common form of head injury, and the incidence of TBI is the highest in young adult males. In Western countries the major causes of TBI-related hospitalizations are falls, assaults, and motor vehicle traffic collisions.

Download Full-text

A Tumble for a Cookie

Pediatric Traumatic Emergencies ◽

10.1093/med/9780190946623.003.0004 ◽

2020 ◽

pp. 33-40

Author(s):

Nancy Rixe

Keyword(s):

United States ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Glasgow Coma Scale ◽

The United States ◽

Minor Head Trauma ◽

Prediction Rules ◽

Coma Scale ◽

Ed Visits

Children with head injury account for more than 800,000 ED visits in the United States each year. Children with minor head trauma (Glasgow Coma Scale [GCS] of 14 or 15) constitute the majority of visits to the ED. Clinicians must balance the risk of cranial radiation with that of missing a clinically important traumatic brain injury (ciTBI). An understanding of the current validated clinical prediction rules for identifying low-risk children in whom CT is likely unnecessary is essential to ensure appropriate care of these children.

Download Full-text

CAN FULL OUTLINE OF UNRESPONSIVENESS SCORE (FOUR) REPLACE GLASGOW COMA SCALE (GCS) IN HEAD INJURY?: VALIDATION AT TERITIARY CARE CENTRE IN NEPAL

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v6i1.21723 ◽

2018 ◽

Vol 6 (1) ◽

pp. 32-39 ◽

Cited By ~ 1

Author(s):

Prakash Kafle ◽

Mohan Raj Sharma ◽

Sushil K Shilpakar ◽

Gopal Sedain ◽

Amit Pradhanang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Glasgow Coma Scale ◽

Outcome Measurement ◽

University Teaching ◽

Predictive Values ◽

Coma Scale ◽

Prediction Of Mortality ◽

Four Score

Introduction : Traumatic brain injury (TBI) is one of the major cause of severe disability and death world wide.The mortality rate in these patients largely depends on initial severity of trauma. In TBI, initial level of consciousness is most important prognostic indicator. The commonest scale is the Glasgow Coma Scale (GCS). Despite its widespread use, the GCS has some significant limitations, including variations in inter rater reliability and predictive validity. In order to overcome deficiencies of the GCS, an alternative scale called FOUR (Full Outline of Unresponsiveness score) has been developed and validated in several neurosurgical centers in North America. This study was an attempt to validate this score in Nepalese Setting. This study was carried out in the Department of Neurosurgery at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The main objective ofthe study was to compare the FOUR with GCS in predicting outcome in patients with Traumatic brain injury.MATERIAL AND METHODS: Patients with moderate to severe head injury aged 2: 16 years admitted in the Department ofNeurosurgery were eligible to participate in the study.The GCS and FOUR score were measured at the earliest possible time during admission by the single observer. Glasgow Outcome Scale (GOS) was measured at discharge and at 3 months follow up. Mortality was used as the primary outcome measure.RESULTS: Total of 122 patients were included in the study. The mean age of the study population was 38.7 ± 18 years. Mean GCS score among survivors was higher than that among non-survivors which was statistically significant (10.9 ± 2 vs. 6 ± 1.12 (p <0.001). Similarly mean FOUR score among survivors was significantly higher than that among non-survivors ( 12. 8±2.49 vs. 6.08 ± 1.72 (p< 0.001). The cut off point for GCS and FOUR score were ≤ 7and ≤ 8 respectively. The area under ROC curve for GCS for prediction of mortality was 0.975 (95% CI; 0.947-1.000; p<0.001) and for FOUR score was 0.981 (95% CI; 0.960-1.000; p<0.001) suggesting good discrimination ability ofboth models.The overall sensitivity, specificity, positive predictive value and negative predictive values of GCS were 91.67%, 91.82%, 55% and 99% respectively while that for FOUR score were 100%, 91.82%, 57.1 % and 100%respectively.CONCLUSION: The outcome measurement of FOUR score was comparable with the GCS in traumatic brain injury and both the scores correlated well.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 32-39

Download Full-text

Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India

Journal of Child Neurology ◽

10.1177/0883073820944040 ◽

2020 ◽

Vol 35 (14) ◽

pp. 970-974

Author(s):

Priyanka Madaan ◽

Deepak Agrawal ◽

Deepak Gupta ◽

Atin Kumar ◽

Prashant Jauhari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Accidental Falls ◽

Road Traffic ◽

Head Injuries ◽

Skull Fracture ◽

Care Hospital ◽

Pediatric Traumatic Brain Injury ◽

Coma Scale

Traumatic brain injury is an important cause of acquired brain injury. The current study brings to light the clinicoepidemiologic profile of pediatric traumatic brain injury in India. Retrospective record analysis of children (aged ≤ 16 years) with traumatic brain injury presenting to an apex-trauma-center in North India over 4 years was done. Of more than 15 000 patients with a suspected head injury, 4833 were children ≤16 years old. Of these, 1074 were admitted to the inpatient department; 65% were boys with a mean age at presentation being 6.6 years. Most patients (85%) had a Glasgow Coma Scale score of 13 to 15 at presentation while Glasgow Coma Scale scores of ≤8 was seen in 10% of patients. Neuroimaging (computed tomography [CT]) abnormalities were seen in 12% of patients, with the commonest abnormality being skull fracture, followed by contusions, and extradural hemorrhage. Around 2% of patients required decompressive craniotomy whereas 3% of patients succumbed to their illness. Among the inpatients with pediatric traumatic brain injury, two-thirds were boys with a mean age at presentation of 7.6 years. Severity of traumatic brain injury varied as mild (64%), moderate (11%), and severe (25%). The most common mode of injury was accidental falls (59%) followed by road traffic and rail accidents (34%). Neuroimaging abnormalities were seen in half of inpatients with pediatric traumatic brain injury, with the commonest abnormality being skull fracture. Pediatric head injuries are an important public health problem and constitute a third of all head injuries. They are more common in boys, and the most common modes of injury are accidental falls, followed by road traffic accidents.

Download Full-text

Is the Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improve the Prediction of Outcome in Traumatic brain injury Patients?

Zagazig University Medical Journal ◽

10.21608/zumj.2019.10082.1074 ◽

2019 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Naglaa Abdelhaleem ◽

Howaydah Othman ◽

Ghada Abdel Razek ◽

Essam Abdel Galel ◽

Ahmed Soliman

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Transcranial Doppler ◽

Pulsatility Index ◽

Prediction Of Outcome ◽

Coma Scale

Download Full-text

Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

Brain Sciences ◽

10.3390/brainsci11081044 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1044

Author(s):

Cristina Daia ◽

Cristian Scheau ◽

Aura Spinu ◽

Ioana Andone ◽

Cristina Popescu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Severe Traumatic Brain Injury ◽

Functional Independence ◽

Unresponsive Wakefulness Syndrome ◽

Coma Scale ◽

Severe Tbi ◽

Neuroprotective Treatment ◽

Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

Download Full-text