gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The predictive value of the Glasgow coma scale in multiple injuries

Der prädiktive Wert der Glasgow coma scale beim Polytrauma

Meeting Abstract

  • corresponding author R. Firsching - Klinik für Neurochirurgie, Universitätsklinikum Magdeburg
  • S. Schreiber - Klinik für Neurochirurgie, Universitätsklinikum Magdeburg
  • D. Woischneck - Klinik für Neurochirurgie, Universitätsklinikum Ulm
  • I. Bondar - Klinik für Neurochirurgie, Universitätsklinikum Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.07.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc106.shtml

Veröffentlicht: 11. April 2007

© 2007 Firsching et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The predictive value of the Glasgow Coma Scale (GCS) had been reported to be high 20 years ago, but several recent studies have questioned the clinical reliability of this widely known classification. We investigated this issue in a multicenter study.

Methods: 800 patients admitted in a comatose state, i.e. a Glasgow Coma Score of less than 9, were analyzed in a multicenter study including 14 neurosurgical units. All patients were admitted with suspected multiple injuries. The GCS, pupillary function and the features hemiparesis and posturing at 24 hours after the injury were statistically related to mortality. The additional lesions such as fractures and thoracic and abdominal injuries were also related to the outcome.

Results: The head injury was more closely related to mortality than to any other single injury. The GCS proved to be not significantly related to mortality. A sum score of 3 points was related with a 12% mortality and a sum score of 4 was related with a 50% mortality at 6 months. Unilateral loss of pupillary function or hemiparesis were related to a 29% mortality, posturing was related toa 54% mortality.

Conclusions: The GCS sum score at 24 hours after the injury did not prove to be closely related to mortality. As a clinical monitor of comatose patients, it appears deceptive to rely on the GCS to indicate a sudden deterioration, which may be in need of urgent surgery. To recognize a deterioration of a comatose patients, the additional at least hourly recording of pupillary function, hemiparesis and posturing are superior parameters.