Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3

Demetrios Demetriades, Eric Kuncir, George C. Velmahos, Peter M Rhee, Kathy Alo, Linda S. Chan

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Hypothesis: To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3. Design: Trauma registry study. Setting: Level I urban trauma center. Patients: A total of 760 patients with head injury with an admission Glasgow Coma Scale score of 3. Analysis was performed in all patients and in only patients who reached the hospital alive and had no major extracranial injuries (exclusion of patients with a chest or abdominal Abbreviated Injury Score [AIS] >3). Main Outcome Measures: Stepwise logistic regression analysis was used to identify independent risk factors associated with mortality. Results: Blunt trauma accounted for 477 (63%) and penetrating trauma for 283 (37%) of the 760 head injuries. Penetrating trauma was significantly more likely to be associated with a lack of vital signs on admission (15% vs 9%; P = .03). Overall mortality was 76% (94% for penetrating injuries and 65% for blunt injuries; P<.001). Overall, 79% of patients had a head AIS of 4 or greater. Mortality in the subgroup was 64% (320/497) and was significantly higher in penetrating vs blunt trauma (89% vs 52%; P<.001). Penetrating trauma, high head AIS, hypotension on admission, and age older than 55 years were independent significant risk factors associated with mortality. Only 10% of the 177 survivors had good functional outcome at hospital discharge. Eighty-six patients (17% of those with vital signs on admission) became organ donors. Conclusions: Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.

Original languageEnglish (US)
Pages (from-to)1066-1068
Number of pages3
JournalArchives of Surgery
Volume139
Issue number10
DOIs
StatePublished - Oct 2004
Externally publishedYes

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Glasgow Coma Scale
Craniocerebral Trauma
Wounds and Injuries
Mortality
Vital Signs
Hypotension
Abdominal Injuries
Nonpenetrating Wounds
Tissue and Organ Procurement
Trauma Centers
Survivors
Registries
Thorax
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Tissue Donors

ASJC Scopus subject areas

  • Surgery

Cite this

Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3. / Demetriades, Demetrios; Kuncir, Eric; Velmahos, George C.; Rhee, Peter M; Alo, Kathy; Chan, Linda S.

In: Archives of Surgery, Vol. 139, No. 10, 10.2004, p. 1066-1068.

Research output: Contribution to journalArticle

Demetriades, Demetrios ; Kuncir, Eric ; Velmahos, George C. ; Rhee, Peter M ; Alo, Kathy ; Chan, Linda S. / Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3. In: Archives of Surgery. 2004 ; Vol. 139, No. 10. pp. 1066-1068.
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abstract = "Hypothesis: To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3. Design: Trauma registry study. Setting: Level I urban trauma center. Patients: A total of 760 patients with head injury with an admission Glasgow Coma Scale score of 3. Analysis was performed in all patients and in only patients who reached the hospital alive and had no major extracranial injuries (exclusion of patients with a chest or abdominal Abbreviated Injury Score [AIS] >3). Main Outcome Measures: Stepwise logistic regression analysis was used to identify independent risk factors associated with mortality. Results: Blunt trauma accounted for 477 (63{\%}) and penetrating trauma for 283 (37{\%}) of the 760 head injuries. Penetrating trauma was significantly more likely to be associated with a lack of vital signs on admission (15{\%} vs 9{\%}; P = .03). Overall mortality was 76{\%} (94{\%} for penetrating injuries and 65{\%} for blunt injuries; P<.001). Overall, 79{\%} of patients had a head AIS of 4 or greater. Mortality in the subgroup was 64{\%} (320/497) and was significantly higher in penetrating vs blunt trauma (89{\%} vs 52{\%}; P<.001). Penetrating trauma, high head AIS, hypotension on admission, and age older than 55 years were independent significant risk factors associated with mortality. Only 10{\%} of the 177 survivors had good functional outcome at hospital discharge. Eighty-six patients (17{\%} of those with vital signs on admission) became organ donors. Conclusions: Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.",
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AU - Alo, Kathy

AU - Chan, Linda S.

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N2 - Hypothesis: To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3. Design: Trauma registry study. Setting: Level I urban trauma center. Patients: A total of 760 patients with head injury with an admission Glasgow Coma Scale score of 3. Analysis was performed in all patients and in only patients who reached the hospital alive and had no major extracranial injuries (exclusion of patients with a chest or abdominal Abbreviated Injury Score [AIS] >3). Main Outcome Measures: Stepwise logistic regression analysis was used to identify independent risk factors associated with mortality. Results: Blunt trauma accounted for 477 (63%) and penetrating trauma for 283 (37%) of the 760 head injuries. Penetrating trauma was significantly more likely to be associated with a lack of vital signs on admission (15% vs 9%; P = .03). Overall mortality was 76% (94% for penetrating injuries and 65% for blunt injuries; P<.001). Overall, 79% of patients had a head AIS of 4 or greater. Mortality in the subgroup was 64% (320/497) and was significantly higher in penetrating vs blunt trauma (89% vs 52%; P<.001). Penetrating trauma, high head AIS, hypotension on admission, and age older than 55 years were independent significant risk factors associated with mortality. Only 10% of the 177 survivors had good functional outcome at hospital discharge. Eighty-six patients (17% of those with vital signs on admission) became organ donors. Conclusions: Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.

AB - Hypothesis: To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3. Design: Trauma registry study. Setting: Level I urban trauma center. Patients: A total of 760 patients with head injury with an admission Glasgow Coma Scale score of 3. Analysis was performed in all patients and in only patients who reached the hospital alive and had no major extracranial injuries (exclusion of patients with a chest or abdominal Abbreviated Injury Score [AIS] >3). Main Outcome Measures: Stepwise logistic regression analysis was used to identify independent risk factors associated with mortality. Results: Blunt trauma accounted for 477 (63%) and penetrating trauma for 283 (37%) of the 760 head injuries. Penetrating trauma was significantly more likely to be associated with a lack of vital signs on admission (15% vs 9%; P = .03). Overall mortality was 76% (94% for penetrating injuries and 65% for blunt injuries; P<.001). Overall, 79% of patients had a head AIS of 4 or greater. Mortality in the subgroup was 64% (320/497) and was significantly higher in penetrating vs blunt trauma (89% vs 52%; P<.001). Penetrating trauma, high head AIS, hypotension on admission, and age older than 55 years were independent significant risk factors associated with mortality. Only 10% of the 177 survivors had good functional outcome at hospital discharge. Eighty-six patients (17% of those with vital signs on admission) became organ donors. Conclusions: Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.

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