78.17 The Impact of Change in GCS Score on Outcomes After Traumatic Brain Injury

Posted on January 18, 2016

H. Aziz1, P. Rhee1, A. A. Haider1, N. Kulvatunyou1, A. Tang1, T. O’Keeffe1, D. J. Green1, R. Latifi1, R. S. Friese1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA

Introduction:
Glasgow coma scale (GCS) score is used widely to assess the neurological status of patients with traumatic brain injury (TBI). However, the role of change in GCS score as a prognostic indicator in these patients has never been studied before. We hypothesized that change in GCS score at 6-hours after arrival reliably predicts mortality and need for delayed neurosurgical intervention in patients with TBI.

Methods:
We performed a 2-year (2013-2014) retrospective analysis of all patients with a diagnosis of intracranial hemorrhage on initial CT scan. We divided our patient population into 2 groups, patients with unchanged or improved 6-hour GCS score and patients with a decline in GCS scores. Our primary outcome measures were; mortality, delayed craniotomy (> 6-hour), and progression of intracranial bleed. Secondary outcome measures were; hospital and ICU length of stay. Multivariable logistic regression analysis was performed

Results:
A total of 232 patients were included. Mean age was 45.8±25.2 years and median head-AIS was 3 [3-4]. 138 (58.5%) patients had an improved 6-hour GCS score as compared to their admission GCS score. The rates of mortality (2.4% vs. 18.1; p<0.001), delayed craniotomy (0.8% vs. 11.4%; p=0.001), and progression of head bleed (6.3% vs. 16.2%; p=0.02) were significantly lower in the patients with improved 6 hour-GCS scores. Improved 6-hour GCS score was independently associated with lower odds of mortality (OR [CI]; 0.1 [0.02-0.53]; p=0.007). Even in the subgroup of severe TBI patients, an improved 6-hour GCS score was independently associated with lower odds of mortality (OR [CI]; 0.09 [0.01-0.81], p=0.03)

Conclusion:
An improvement in 6-hour GCS following traumatic brain injury is associated with lower odds of mortality. This may help direct critical decisions in patients in whom the prognosis following traumatic brain injury is unclear.