Traumatic brain injury: It is all about definition
- 28 July 2016
- journal article
- research article
- Published by Taylor & Francis Ltd in Brain Injury
- Vol. 30 (10), 1194-1200
- https://doi.org/10.1080/02699052.2016.1187290
Abstract
Background: TBI may be defined by different methods. Some may be most useful for immediate clinical purposes, however less optimal for epidemiologic research. Other methods, such as the Abbreviated Injury Score (AIS), may prove more beneficial for this task, if the cut-off-points for their categories are defined correctly. Objective: To reveal the optimal cut-off-points for AIS in definition of severity of TBI in order to ensure uniformity between future studies of TBI. Results: Mortality of patients with TBI AIS 3, 4 was 1.9% and 2.9% respectively, comparing with 31.1% among TBI AIS 5+. Predictive discrimination ability of the model with cut-off-points of 5+ for TBI AIS (in comparison with other cut-off-points) was better. Patients with missing Glasgow Coma Scale (GCS) in the ED had an in-hospital mortality rate of 11.5%. In this group, 25% had critical TBI according to AIS. Normal GCS didn’t indicate an absence of head injury, as, among patients with GCS 15 in the ED, 26% had serious/critical TBI injury. Moreover, 7% of patients with multiple injury and GCS 3–8 had another reason than head injury for unconsciousness. Conclusions: This study recommends the adoption of an AIS cut-off ≥ 5 as a valid definition of severe TBI in epidemiological studies, while AIS 3–4 may be defined as ‘moderate’ TBI and AIS 1–2 as ‘mild’.Keywords
This publication has 21 references indexed in Scilit:
- The Glasgow Coma Scale at 40 years: standing the test of timeThe Lancet Neurology, 2014
- Changing patterns in the epidemiology of traumatic brain injuryNature Reviews Neurology, 2013
- Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma CentersPrehospital Emergency Care, 2011
- Trauma Registries: History, Logistics, Limitations, and Contributions to Emergency Medicine ResearchAcademic Emergency Medicine, 2011
- Diagnostic Value of the Glasgow Coma Scale for Traumatic Brain Injury in 18,002 Patients with Severe Multiple InjuriesJournal of Neurotrauma, 2011
- Diagnostic criteria and the use of ICD-10 codes to define and classify minor head injuryJournal of Neurology, Neurosurgery & Psychiatry, 2003
- Prehospital Intubation in Patients with Severe Head InjuryThe Journal of Trauma and Acute Care Surgery, 2000
- The abbreviated injury scale as a predictor of outcome of severe head injuryIntensive Care Medicine, 1995
- PROBLEMS WITH INITIAL GLASGOW COMA SCALE ASSESSMENT CAUSED BY PREHOSPITAL TREATMENT OF PATIENTS WITH HEAD INJURIESThe Journal of Trauma and Acute Care Surgery, 1994
- ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical ScaleThe Lancet, 1974