Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation
- 1 October 2009
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 111 (4), 683-687
- https://doi.org/10.3171/2009.2.jns08817
Abstract
A Glasgow Coma Scale (GCS) score of 3 on presentation in patients with severe traumatic brain injury due to blunt trauma has been recognized as a bad prognostic factor. The reported mortality rate in these patients is very high, even approaching 100% in the presence of fixed and dilated pupils in some series. Consequently, there is often a tendency to treat these patients less aggressively because of the low expectations for a good recovery. In this paper, the authors' purpose is to report their experience in the management of this patient population, analyzing the mortality rate, prognostic factors, and functional outcome of survivors. The authors performed a retrospective review of patients who presented between 1997 and 2007 with blunt head trauma and a GCS score of 3. Demographics, mechanism of injury, examination, blood alcohol level, associated injury, intracranial pressure (ICP), surgical procedures, and outcome were all recorded. A total of 189 patients met the inclusion criteria and were included in this study. The overall mortality rate was 49.2%. At the 6-month follow-up, 13.2% of the entire series achieved a good functional outcome (Glasgow Outcome Scale [GOS] score of 1 or 2). The patient population was then divided into 2 groups: Group 1 (patients who survived [96]) and Group 2 (patients who died [93]). Patients in Group 1 were younger (mean 33.3 ± 12.8 vs 40.3 ± 16.97 years; p = 0.002) and had lower ICP on admission (mean 16.3 ± 11.1 vs 25.7 ± 12.7 mm Hg; p < 0.001) than those in Group 2. The difference between the 2 groups regarding sex, mechanism of injury, hypotension on admission, alcohol, surgery, and associated injuries was not statistically significant. The presence of bilateral fixed, dilated pupils was found to be associated with the highest mortality rate (79.7%). Although not statistically significant because of the sample size, pupil status was also a good predictor of the functional outcome at the 6-month follow-up; a good functional outcome (GOS Score 1 or 2) was achieved in 25.5% of patients presenting with bilateral reactive pupils, and 27.6% of patients presenting with a unilateral fixed, dilated pupil, compared with 7.5% for those presenting with bilateral fixed, nondilated pupils, and 1.4% for patients with bilateral fixed, dilated pupils. Overall, 50.8% of patients survived their injury and 13.2% achieved a good functional outcome after at 6 months of follow-up (GOS Score 1 or 2). Age, ICP on admission, and pupil status were found to be significant predictive factors of outcome. In particular, pupil size and reactivity appeared to be the most important prognostic factor since the mortality rate was 23.5% in the presence of bilateral reactive pupils and 79.7% in the case of bilateral fixed, dilated pupils. The authors believe that patients having suffered traumatic brain injury and present with a GCS score of 3 should still be treated aggressively initially since a good functional outcome can be obtained in some cases.Keywords
This publication has 15 references indexed in Scilit:
- Do Trauma Patients with a Glasgow Coma Scale Score of 3 and Bilateral Fixed and Dilated Pupils Have Any Chance of Survival?Journal Of Trauma-Injury Infection and Critical Care, 2006
- Use of Admission Glasgow Coma Score, Pupil Size, and Pupil Reactivity to Determine Outcome for Trauma PatientsJournal Of Trauma-Injury Infection and Critical Care, 2003
- Predicting survival using simple clinical variables: a case study in traumatic brain injuryJournal of Neurology, Neurosurgery & Psychiatry, 1999
- COMPARISON OF MORTALITY, MORBIDITY, AND SEVERITY OF 59,713 HEAD INJURED PATIENTS WITH 114,447 PATIENTS WITH EXTRACRANIAL INJURIESJournal Of Trauma-Injury Infection and Critical Care, 1994
- Outcome and outcome prediction in acute subdural hematomaSurgical Neurology, 1993
- THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURYJournal Of Trauma-Injury Infection and Critical Care, 1993
- The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variablesBritish Journal Of Neurosurgery, 1993
- Global spine and head injury prevention project (SHIP)Surgical Neurology, 1992
- Is Early Prediction of Outcome in Severe Head Injury Possible?Archives of Surgery, 1991
- Initial CT findings in 753 patients with severe head injuryJournal of Neurosurgery, 1990