Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less.

Alexander Becker; Kobi Peleg; Oded Olsha; Adi Givon; Boris Kessel; Israeli Trauma Group

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Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less.

Author: Alexander BECKER ^{1
,

2} ; Kobi PELEG ^{3
,

4} ; Oded OLSHA ⁵ ; Adi GIVON ⁶ ; Boris KESSEL ^{7
,

8} ; Israeli Trauma Group
Author Information

1. Department of Surgery A, Emek Medical Center, Afula, Israel
2. Rappoport Medical School, Technion, Haifa, Israel. Electronic address: alexb20042000@yahoo.com.
3. National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
4. Disaster Medicine Department, School of Public Health, Faculty of Medicine, TelAviv University, Israel.
5. Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
6. National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
7. Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
8. Rappoport Medical School, Technion, Haifa, Israel.
Collective Name:Israeli Trauma Group
Publication Type:Journal Article
Keywords: Glasgow Coma Scale; Multiple trauma; Transfer
MeSH: Brain Injuries, Traumatic; epidemiology; Glasgow Coma Scale; Humans; Incidence; Retrospective Studies; Wounds, Nonpenetrating; epidemiology
From: Chinese Journal of Traumatology 2018;21(3):152-155
CountryChina
Language:English
Abstract:
PURPOSEEarly diagnosis of traumatic brain injury (TBI) is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale (GCS) of 12 or less can predict the presence of TBI and the severity of associated injuries in blunt trauma patients.
METHODSA retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel's National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant.
RESULTSThere were 303,435 blunt trauma patients, 8731 (2.9%) of them with GCS of 3-12 that including 6351 (72%) patients with GCS of 3-8 and 2380 (28%) patient with GCS of 9-12. In these 8731 patients with GCS of 3-12, 5372 (61.5%) patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12, 1256 (89%) patients with GCS 3-8, 148 (11%) patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TBI. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI.
CONCLUSIONThe utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.