Is it possible to recover from traumatic brain injury and a Glasgow coma scale score of 3 at emergency department presentation?

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Abstract

Introduction

A Glasgow Coma Scale (GCS) score of 3 on presentation in patients with traumatic brain injury (TBI) portends a poor prognosis. Consequently, there is often a tendency to treat these patients less aggressively because of low expectations for a good outcome.

Methods and results

We performed a retrospective review of patients with TBI and a GCS score of 3. Patients were divided into 2 groups based on Glasgow Outcome Scale (GOS): Group 1 (GOS = 1–3) and Group 2 (GOS = 4–5). A total of 62 patients were included. The overall mortality rate was 80.6%. At 6-month, 9 patients (14.5%) achieved a GOS 4–5. Compared to Group 2 (n = 9), Group 1 (n = 53) had higher average APACHE IV score (104 ± 19 vs 89 ± 27, p = 0.04), more patients with bilateral fixed pupils (59% vs 22%, p = 0.04), and higher ICP burden (50 ± 34 vs 0 ± 0, p = 0.0001). Using the CRASH calculator, the estimated mortality at 14 days was 66% compared to actual mortality of 81%; difference of 15%, (p = 0.05), and the estimated GOS 1–3 was 85.5% compared to actual of 85.5%, (p = 1.0).

Conclusions

14.5% of patients with TBI and a GCS of 3 at presentation achieved a good outcome at 6 months, and 6.9% of patients with GCS of 3 and bilateral fixed pupils on presentation to the ED achieved a good outcome at 6 months.

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