Itamar Ashkenazi1, William P Schecter2, Kobi Peleg3, Adi Givon4, Oded Olsha5, Fernando Turegano-Fuentes6, Ricardo Alfici1, Hany Bahouth7, Alexander Becker8, Michael Ben Ely9, Alexander Braslavsky10, Igor Jeroukhimov11, Milad Qarawany12, Boris Kessel13, Yoram Klein14, Guy Lin15, Ofer Merin16, Miklosh Bala17, Youri Mnouskin18, Avraham I Rivkind17, Gad Shaked19, Dror Soffer20, Michael Stein21, Michael Weiss22. 1. Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel. 2. Department of Surgery, University of California, San Francisco. 3. National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel4Disaster Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel. 5. Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. 6. Emergency Surgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain. 7. Trauma and Emergency Surgery Division of General Surgery, Rambam Health Care Campus, Haifa, Israel. 8. Department of Surgery, HaEmek Medical Center, Afula, Ruth and Bruce Rappaport Medical School, Technion, Haifa, Israel. 9. Wolfson Medical Center, Holon, Israel. 10. Trauma Unit, Ziv Medical Center, Zfat, Israel. 11. Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel. 12. Trauma Unit, Poriya Medical Center, Tiberias, Israel. 13. Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel14Bruce Rappaport Medical School, Technion, Haifa, Israel. 14. Divison of Acute Care Surgery and Trauma, Chaim Sheba Medical Center, Tel Hashomer, Israel. 15. Kaplan Medical Center, Rehovot, Israel. 16. Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel. 17. Hadassah Medical Center, Jerusalem, Israel. 18. Surgery Department, Barzilai Medical Center, Ashkelon, Israel. 19. Trauma Unit, Soroka Medical Center, Beer-Sheva, Israel. 20. The Yitzhak Rabin Trauma Division, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 21. Trauma Unit, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel. 22. Trauma Unit, Galilee Medical Center, Nahariya, Israel.
Abstract
Importance: Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion. Objective: To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention. Design, Setting, and Participants: Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015. Main Outcomes and Measures: Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score. Results: Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P < .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P < .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores. Conclusions and Relevance: Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.
Importance: Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion. Objective: To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention. Design, Setting, and Participants: Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015. Main Outcomes and Measures: Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score. Results: Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P < .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P < .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores. Conclusions and Relevance: Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.
Authors: Johan Ljungqvist; Stefan Candefjord; Mikael Persson; Lars Jönsson; Thomas Skoglund; Mikael Elam Journal: J Neurotrauma Date: 2017-03-13 Impact factor: 5.269