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

Peleg, Kobi; Olsha, Oded; Givon, Adi; Kessel, Boris; Bahouth, Hany; Becker, Alexander; Hadary, Amram; Jeroukhimov, M.; Karawani, I.; Klein, Yoram; Lin, Guangyu; Merin, Ofer; Miklosh, B.; Mnouskin, Y.; Rivkind, Avraham I.; Shaked, Gad; Sivak, Galit; Soffer, Dror; Stein, Murray B.; Weiss, Martin H.

doi:10.1016/j.cjtee.2018.01.004

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…Furthermore, our observation has advantage over some clinical papers that investigated some of the related clinical scales. For example, according to the Glasgow Coma Scale, the neurological symptoms of the patient showed no evidence for a predictive value for intracranial lesions [13].…”

Section: Discussionmentioning

confidence: 92%

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

Klempka

Fischer

Kauczor

et al. 2020

Rofo

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Purpose To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries, assessed using whole-body computed tomography (WBCT), and to determine if these are valid markers for internal injuries. Methods and Materials 250 patients who underwent WBCT emergency scans for suspected polytrauma were retrospectively analyzed after institutional review board approval of the study. The scans were carried out on patients who met the criteria for standard operating procedures for WBCT emergency scans. WBCT covering the entire head, neck, chest, and abdomen (including pelvis and proximal lower extremities) and at least one phase with intravenous contrast agent were included in the study. Initial analyses of immediate WBCT scans was carried out by a consultant radiologist and a radiological resident. The first reading focused on internal damage that needed immediate therapy. The second reading focused on a detailed analysis of the skin and subcutaneous tissue and their relation to internal injuries without the time pressure of an emergency setting, carried out by another experienced radiologist. All skin lesions and the degree of penetration and a comparison between the two readings were reported in tables. Results Superficial lesion of the chest was detected in 19 patients, 17 of them had an internal injury of the thorax while only two patients, with hematoma of the chest wall, had no internal injuries. Skin and subcutaneous lesions of the chest had the strongest association with an internal injury. Skin lesions of the abdominal wall were observed in 30 patients. In only 11 cases, these lesions were correlated with internal injuries, such as fractures or active bleeding. 52 skin and subgaleal lesions of the scalp were observed. In 20 of these patients, an intracranial or internal injury was detected. In 3 patients, skin abrasions of the neck were present and in only one of them, this finding was associated with an internal injury. Conclusion Trauma patients whose history and clinical presentation meet the standard operating procedures for WBCT emergency scans and who present with a cutaneous lesion, especially at the neurocranium or chest wall, should be observed for internal injuries by WBCT. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 92%

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

Klempka

Fischer

Kauczor

et al. 2020

Rofo

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“…Clinical severity and outcome of traumatic brain injuries are frequently defined by GCS. However, the use of GCS ≤12 in traumatic brain injury is of limited value in patients with multiple injuries [ 18 ]. Moreover, the components of GCS have a different effect on the sum of GCS and consciousness [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The severity of fall injuries in Saudi Arabia: a cross-sectional study

Razik¹,

Alslimah²,

Alghamdi³

et al. 2020

Pan Afr Med J

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Introduction fall injuries constitute a major public health concern worldwide, contributing to over 646,000 deaths every year. The aim of this study was to determine the nature and severity of fall injuries at a tertiary hospital in the Kingdom of Saudi Arabia (KSA). Methods we conducted a cross-sectional study at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. We recruited the patients and followed them through the triage, admission and discharge processes. We analyzed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including the nature, cause, mechanism of injury, demographic characteristics and prognostic factors captured through the injury severity score (ISS), the Glasgow coma scale (GCS) and the presence or absence of shock. Results of 264 patients, most of the patients were children under the age of ten (25.7%), followed by young adults between the ages of twenty-one and thirty (18.2%). The ISS was associated with severe head, chest, skull, brain, scalp, rib, abdominal, pelvic and lower limb injuries. The GCS was associated with severe the head, chest, skull, brain and rib injuries (p<0.005). The degree of shock was also significantly associated with pelvic, head, chest, skull, brain, scalp, abdominal and upper limb injuries (p<0.05). Conclusion: fall injuries in our setting are severe. Training of staff should prioritize head, chest, skull, brain, abdominal and rib injury management. As a reference hospital, minor injuries are more likely to be managed at lower levels of care.

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“…There are also several limitations. The GCS is usually used to determine TBI severity [7], but its general applicability as a severity measure is also criticised [5]. The GCS could have been influenced by intoxication, pharmacological sedation, prehospital intubation, extracranial injury and could thereby have over-and underestimated injury severity [54].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

et al. 2020

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Background The high occurrence and acute and chronic sequelae of traumatic brain injury (TBI) cause major healthcare and socioeconomic challenges. This study aimed to describe outcome, in-hospital healthcare consumption and in-hospital costs of patients with TBI. Methods We used data from hospitalised TBI patients that were included in the prospective observational CENTER-TBI study in three Dutch Level I Trauma Centres from 2015 to 2017. Clinical data was completed with data on in-hospital healthcare consumption and costs. TBI severity was classified using the Glasgow Coma Score (GCS). Patient outcome was measured by inhospital mortality and Glasgow Outcome Score-Extended (GOSE) at 6 months. In-hospital costs were calculated following the Dutch guidelines for cost calculation. Results A total of 486 TBI patients were included. Mean age was 56.1 ± 22.4 years and mean GCS was 12.7 ± 3.8. Six-month mortality (4.2%-66.7%), unfavourable outcome (GOSE ≤ 4) (14.6%-80.4%) and full recovery (GOSE = 8) (32.5%-5.9%) rates varied from patients with mild TBI (GCS13-15) to very severe TBI (GCS3-5). Length of stay (8 ± 13 days) and in-hospital costs (€11,920) were substantial and increased with higher TBI severity, presence of intracranial abnormalities, extracranial injury and surgical intervention. Costs were primarily driven by admission (66%) and surgery (13%). Conclusion In-hospital mortality and unfavourable outcome rates were rather high, but many patients also achieved full recovery. Hospitalised TBI patients show substantial in-hospital healthcare consumption and costs, even in patients with mild TBI. Because these costs are likely to be an underestimation of the actual total costs, more research is required to investigate the actual costseffectiveness of TBI care. Keywords Traumatic brain injury. In-hospital costs. Mortality. Functional outcome This article is part of the Topical Collection on Brain trauma Electronic supplementary material The online version of this article (

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

Cited by 13 publications

References 19 publications

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury

The severity of fall injuries in Saudi Arabia: a cross-sectional study

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

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