Underestimated Traumatic Brain Injury in Multiple Injured Patients; Is the Glasgow Coma Scale a Reliable Tool?

Background: Traumatic brain injuries are common in multiple injured patients. Here, the impact of traumatic brain injuries according age and mortality and predictive value was investigated.

Methods: Totally 2952 patients were included into this sample. The inclusion criteria were age ≥ 16 years and an injury severity score >16. The patient sample was divided into 8 groups according to the age decades. Data were analyzed using IBM SPSS® for Windows version 22.0; analysis of variance was used for continuous normally distributed data and χ2 test was used for categorical data. The predictive quality for death of the different injuries was analyzed using receiver operating characteristic curves and is given as area under the curve (AUC). Independent predictivity was analyzed by binary logistic regression. Data were considered significant if p<0.05. Data are presented as the mean ± standard deviation.

Results: The analysis revealed a discrepancy in the predictive quality of GCS (AUC: 0.223, p<0.001) and the abbreviated injury score (AIS) for the head (AUC: 0.764, p<0.001). The highest predictive quality of the AIS head for death was shown in the decade of 36-45 years (AUC: 0.832, p<0.001). The traumatic brain injury revealed as an independent predictor of death (p<0.001). The mortality rate was increasing according to the age significantly within the decades (p<0.001).

Conclusion: Even if the initial GCS indicates an intermediate traumatic brain injury, attention should be given to aggravating dynamics of the traumatic brain injury.

Level of evidence: Retrospective cohort study: Level II.


Ladislav Mica, Kai Oliver Jensen, Catharina Keller, Stefan H. Wirth, Hanspeter Simmen and Kai Sprengel

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  • Geneva Foundation for Medical Education and Research