Article
The Glasgow Coma Scale and pupillary light reflex as predictors of mortality in polytrauma patients
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Authors
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J. Nijboer
- University Hospital Groningen, Department of Surgery, Groningen, the Netherlands
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J. van der Naalt
- University Hospital Groningen, Department of Neurology, Groningen, the Netherlands
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H. ten Duis
- University Hospital Groningen, Department of Surgery, Groningen, the Netherlands
| Published: | October 19, 2004 |
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Outline
Text
Introduction
Do a minimal Glasgow Coma Scale (GCS) and absent pupillary light reflexes in trauma patients indicate mortality to a similar extent in patients with traumatic brain injury and patients in shock?
Methods
The study population was extracted from the Trauma Registry Database of Polytrauma Patients of our hospital, a level 1 trauma center. Data from September 1st 2002 to January 1st 2004 were analyzed. The inclusion criterion was a GCS of 3, scored by a neurologist shortly after arrival in the trauma room, no age restrictions were set.
The pupillary light reflexes were scored as bilateral positive, bilateral negative, and unilateral negative. A patient was considered suffering from hypovolemic shock if the blood pressure was < 90 mm Hg with a pulse rate > 120 beats / minute not sufficiently responding to fluid resuscitation combined with a serum hemoglobin concentration indicating severe blood loss. Traumatic brain injury (TBI) was diagnosed based on abnormalities on cerebral computerized tomography.
All statistical analyses were performed using SPSS 10.0 for Windows.
Results
In total 350 polytrauma patients were admitted to the trauma center.
After analysis of the first 200 patients a total of 29 patients met the criteria to be included in the study.
Twelve patients scored a bilateral positive light reflex, 13 patients scored a bilateral negative light reflex and 4 patients scored a unilateral negative light reflex. Of these patients, 16,7% suffered from hypovolemic shock without TBI, 56,7% suffered from TBI without hypovolemic shock and 23,3% suffered from a combination of hypovolemic shock and TBI.
Of the patients in shock without TBI, 80% died; 100% of the patients with a bilateral negative or unilateral negative reflex. Of those patients with a bilateral positive reflex two-third died.
Of the patients suffering from TBI without shock 70,6% died; 85,7% of the patients with a bilateral negative reflex, and all patients with a unilateral negative reflex.
The patients in shock combined with TBI showed the highest mortality, 85,7% died; 100% of the patients with a bilateral negative pupillary reflex, and 50% of patients with a unilateral positive reflex.
Further data with respect to GCS-scores will be presented.
Conclusions
An evident trend is noticeable: patients suffering from a hypovolemic shock with a GCS of 3, irrespective of additional TBI, are very likely to die. Especially those patients with absent pupillary light reflexes on admission. Treating the hypovolemic shock will not reverse the unresponsive state, apparently the minimal GCS represents a fatal hypoxic state of the cerebrum.
