Skip to main content
SpringerLink
Log in

Deep coma does not always predict poor outcomes among patients with polytrauma

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purposes

This study aimed to clarify the prognosis of polytrauma patients presenting to the emergency department (ED) with a Glasgow Coma Scale score (GCS) of 3.

Methods

A trauma registry system has been established at our institution since 2009. The current study reviewed patients in the registry who presented to the ED with a GCS of 3 from January 2011 to December 2015. Surviving and non-surviving patients were compared to identify the prognostic factors of patient survival. The study also aimed to determine the factors contributing to patients who survived with a GCS > 13 at discharge.

Results

During the study period, 145 patients were enrolled in the study, 119 of whom (82.1%) did not survive the traumatic insult. Of the 26 survivors, 13 (9.0%) had a GCS of 14 or 15 at discharge. The multiple logistic regression revealed that a lack of bilateral dilated and fixed pupils (BFDP) (OR 5.967, 95% CI 1.780–19.997, p = 0.004) and a GCS > 3 after resuscitation (OR 6.875, 95% CI 2.135–22.138, p = 0.001) were independent prognostic factors of survival. Based on the multiple logistic regression, an age under 40 years (OR 16.405, 95% CI 1.520–177.066, p = 0.021) and a GCS > 3 after resuscitation (OR 12.100, 95% CI 1.058–138.352, p = 0.045) were independent prognostic factors of a GCS > 13 at discharge.

Conclusion

Aggressive resuscitation still provided benefit to polytrauma patients presenting with a GCS of 3, especially those with a rapid response to the resuscitation. Young patients with a deep coma on arrival had a higher probability of functional recovery after resuscitation in the ED.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lieberman JD, Pasquale MD, Garcia R, Cipolle MD, Mark Li P, Wasser TE. Use of admission Glasgow Coma Score, pupil size, and pupil reactivity to determine outcome for trauma patients. The Journal of trauma. 2003;55(3):437–42. https://doi.org/10.1097/01.TA.0000081882.79587.17 (discussion 42–3).

    Article  PubMed  Google Scholar 

  2. Tien HC, Cunha JR, Wu SN, Chughtai T, Tremblay LN, Brenneman FD, et al. Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? J Trauma. 2006;60(2):274–8. https://doi.org/10.1097/01.ta.0000197177.13379.f4.

    Article  PubMed  Google Scholar 

  3. Mauritz W, Leitgeb J, Wilbacher I, Majdan M, Janciak I, Brazinova A, et al. Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field. Eur J Emerg Med. 2009;16(3):153–8. https://doi.org/10.1097/MEJ.0b013e32832a0864.

    Article  PubMed  Google Scholar 

  4. Nijboer JM, van der Naalt J, ten Duis HJ. Patients beyond salvation? Various categories of trauma patients with a minimal Glasgow Coma Score. Injury. 2010;41(1):52 – 7. https://doi.org/10.1016/j.injury.2009.05.030.

    Article  PubMed  Google Scholar 

  5. Pickett W, Ardern C, Brison RJ. A population-based study of potential brain injuries requiring emergency care. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2001;165(3):288–92.

    Google Scholar 

  6. Demetriades D, Kuncir E, Velmahos GC, Rhee P, Alo K, Chan LS. Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3. Arch Surg. 2004;139(10):1066–8. https://doi.org/10.1001/archsurg.139.10.1066.

    Article  PubMed  Google Scholar 

  7. Chamoun RB, Robertson CS, Gopinath SP. Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation. J Neurosurg. 2009;111(4):683–7. https://doi.org/10.3171/2009.2.JNS08817.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005;57(6):1173–82 (discussion—82).

    Article  PubMed  Google Scholar 

  9. Waxman K, Sundine MJ, Young RF. Is early prediction of outcome in severe head injury possible? Arch Surg. 1991;126(10):1237–41 (discussion 42).

    Article  CAS  PubMed  Google Scholar 

  10. Pal J, Brown R, Fleiszer D. The value of the Glasgow Coma Scale and Injury Severity Score: predicting outcome in multiple trauma patients with head injury. J Trauma. 1989;29(6):746–8.

    Article  CAS  PubMed  Google Scholar 

  11. Chaudhuri K, Malham GM, Rosenfeld JV. Survival of trauma patients with coma and bilateral fixed dilated pupils. Injury. 2009;40(1):28–32. https://doi.org/10.1016/j.injury.2008.09.004.

    Article  PubMed  Google Scholar 

  12. Jain S, Dharap SB, Gore MA. Early prediction of outcome in very severe closed head injury. Injury. 2008;39(5):598–603. https://doi.org/10.1016/j.injury.2007.06.003.

    Article  PubMed  Google Scholar 

  13. Choi SC, Muizelaar JP, Barnes TY, Marmarou A, Brooks DM, Young HF. Prediction tree for severely head-injured patients. J Neurosurg. 1991;75(2):251–5. https://doi.org/10.3171/jns.1991.75.2.0251.

    Article  CAS  PubMed  Google Scholar 

  14. Hoffmann M, Lefering R, Rueger JM, Kolb JP, Izbicki JR, Ruecker AH, et al. Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. Br J Surg. 2012;99(Suppl 1):122–30. https://doi.org/10.1002/bjs.7707.

    Article  PubMed  Google Scholar 

  15. Quigley MR, Vidovich D, Cantella D, Wilberger JE, Maroon JC, Diamond D. Defining the limits of survivorship after very severe head injury. J Trauma. 1997;42(1):7–10.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan, Republic of China

    Jen-Fu Huang, Chun-Hsiang Ou Yang, Chih-Yuan Fu & Yu-Tung Wu

Authors
  1. Jen-Fu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun-Hsiang Ou Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chih-Yuan Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu-Tung Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chih-Yuan Fu.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The current study was approved by Chang Gung Medical Foundation Institutional Review Broad with the reference No. 201700733B0.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, JF., Ou Yang, CH., Fu, CY. et al. Deep coma does not always predict poor outcomes among patients with polytrauma. Eur J Trauma Emerg Surg 45, 455–460 (2019). https://doi.org/10.1007/s00068-018-0917-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-018-0917-8

Keywords

Search

Navigation