The Glasgow Coma Scale and Prognosis in Gunshot Wounds to the Brain

Kennedy, Frank; González, Pedro; Dang, Chat; Fleming, Arthur; Sterling-Scott, R. P.

doi:10.1097/00005373-199307000-00013

Cited by 81 publications

(41 citation statements)

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“…Kennedy et al [29] showed that the GCS score correlates with outcome following gunshot head injuries. The GCS has later become a standard score and correlates well with findings in head CT scans as well as with clinical outcome [30].…”

Section: Discussionmentioning

confidence: 99%

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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Objective Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain. Materials and methods A total of 724 adult trauma patients with an Injury Severity Score (ISS) C 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni-and multivariate analyses. Results The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16-75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in nonsurvivors of all groups (all p \ 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in nonsurvivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p \ 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury. Conclusion Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis.

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Section: Discussionmentioning

confidence: 99%

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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“…On the other hand, favorable outcome was achieved in some such patients, indicating deep and aggressive debridement of necrotic brain tissue to prevent the further swelling that sharply raises mortality. 23,27) We agree with this approach and performed surgical exposure and deep debridement in patients with any GCS score. We believe that our present results demonstrated that early and aggressive debridement reduces mortality.…”

Section: Discussionmentioning

confidence: 74%

“…17,18) The mortality ranges from 23% to 92% and is markedly higher at 87-100% in patients admitted with poor neurological status. 3,4,8,11,13,16,19,22,23,25,29,34,35,37,39) Many other factors have been associated with mortality including hemodynamic and respiratory status at admission, missile type, pupil diameter and reactivity, and computed tomography (CT) findings. 7,12,19,20,22,28,34,41) Surgical intervention must be performed as soon as possible, if indicated.…”

Section: Introductionmentioning

confidence: 99%

High-Velocity Gunshot Wounds to the Head: Analysis of 135 Patients

Bakir

Temız

Umur

et al. 2005

Neurol. Med. Chir.(Tokyo)

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Head injuries due to high-velocity missiles and shrapnel as a result of military conflicts have become a very important cause of death or severe neurological deficits. Military-type missiles have high velocities and transfer higher amounts of energy to neural tissue, compared to civil-type missiles. This physical phenomenon also causes greater neural tissue destruction. Shrapnel particles derive from blasts and cause less severe injury because of the irregular particle shape and low energy transmission. This study analyzed 135 patients with head trauma, 80 patients (59%) injured by missiles and 55 patients (41%) by shrapnel. Glasgow Coma Scale (GCS) scores at admission were 3 to 7 in 69 patients, 8 to 10 in 29 patients, and 11 to 15 in 37 patients. The most common anatomical localizations were the right frontoparietal region in 42 patients and the left frontoparietal region in 40 patients. One hundred patients (74%) were operated on immediately and 35 patients (26%) were treated conservatively in the intensive care unit. Ten of the 135 patients died (7.4%), seven from missile injury and three from shrapnel injury. In this study, we found that high mortality was associated with low GCS score at admission, presence of multilobar or skull base injuries, and involvement of ventricles. Early and aggressive surgical intervention decreased the mortality.

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“…Previous studies have shown the relationship of multilobar injuries with increased mortality and worse prognosis compared to unilobar injuries [23][24][25][26]. Bihemispheric lesions have also been demonstrated to correlate to increased mortality [13,17,18,26].…”

Section: Discussionmentioning

confidence: 99%