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Primary Clinical Assessment

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Management of Severe Traumatic Brain Injury

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Abstract

As part of the primary care of patients with TBI, some form of assessment of the severity of the injury is needed. Outside the hospital and in the primary care facility, this assessment is currently mostly based on a clinical examination. Different scoring systems have been designed to assess the level of consciousness, and such scoring should together with pupil examination be used repetitively to recognise improvement or deterioration over time. Furthermore, the primary clinical evaluation of the patient can be used as a predictor of long-term outcome.

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References

  • Alvarez M, Nava JM, Rué M, Quintana S. Mortality prediction in head trauma patients: performance of Glasgow Coma Score and general severity systems. Crit Care Med. 1998;26:142–8.

    Article  CAS  Google Scholar 

  • Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    Article  CAS  Google Scholar 

  • Braakman R, Avezaat CJ, Maas AI, Roel M, Schouten HJ. Inter observer agreement in the assessment of the motor response of the Glasgow “Coma” Scale. Clin Neurol Neurosurg. 1977;80:100–6.

    Article  CAS  Google Scholar 

  • Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. Part 1: the GCS-pupils score: an extended index of clinical severity. J Neurosurg. 2018;128:1612–20.

    Article  Google Scholar 

  • Chan HC, Adnan WAW, Jaalam K, Abdullah MR, Abdullah J. Which mild head injured patients should have follow-up after discharge from an accident and emergency ward? A study in a University Hospital setting in Kelantan, Malaysia Southeast. Asian J Trop Med Public Health. 2005;36:982–93.

    CAS  Google Scholar 

  • Chesnut RM. Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma. 1997;42:345.

    Article  CAS  Google Scholar 

  • Chesnut RM, Gautille T, Blunt BA, Klauber MR, Marshall LE. The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location. Neurosurgery. 1994;34:840–5.

    CAS  PubMed  Google Scholar 

  • Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993;7:267–79.

    Article  CAS  Google Scholar 

  • Fujisawa H, Marukawa K, Kida S, Hasegawa M, Yamashita J, Matsui O. Abducens nerve palsy and ipsilateral Horner syndrome: a predicting sign of intracranial carotid injury in a head trauma patient. J Trauma. 2001;50:554–6.

    Article  CAS  Google Scholar 

  • Halley MK, Silva PD, Foley J, Rodarte A. Loss of consciousness: when to perform computed tomography? Pediatr Crit Care Med. 2004;5:230–3.

    Article  Google Scholar 

  • Healey C, Osler TM, Rogers FB, Healey MA, Glance LG, Kilgo PD, Shackford SR, Meredith JW. Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma. 2003;54:671–8.

    Article  CAS  Google Scholar 

  • Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow coma scale in children with blunt head trauma. Acad Emerg Med. 2005;12:814–9.

    Article  Google Scholar 

  • Kung W-M, Tsai S-H, Chiu W-T, Hung K-S, Wang S-P, Lin J-W, Lin M-S. Correlation between Glasgow Coma Score components and survival in patients with traumatic brain injury. Injury. 2010;49:940–4.

    Google Scholar 

  • Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The new injury severity score: a more accurate predictor of in-hospital mortality than the injury severity score. J Trauma. 2004;56:1312–20.

    Article  Google Scholar 

  • MacKenzie EJ, Shapiro S, Eastham JN. The abbreviated injury scale and injury severity score. Levels of inter- and intrarater reliability. Med Care. 1985;23:823–35.

    Article  CAS  Google Scholar 

  • Matis G, Birbilis T. The Glasgow Coma Scale—a brief review. Past, present, future. Acta Neurol Belg. 2008;108:75–89.

    PubMed  Google Scholar 

  • Menegazzi JJ, Davis EA, Sucov AN, Paris PM. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma. 1993;34:46–8.

    Article  CAS  Google Scholar 

  • Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S. The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma. 1998;44:839–44.

    Article  CAS  Google Scholar 

  • Meyer S, Gibb T, Jurkovich GJ. Evaluation and significance of the pupillary light reflex in trauma patients. Ann Emerg Med. 1993;22:1052–7.

    Article  CAS  Google Scholar 

  • Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PR, Selhorst JB, Lutz HA, Becker DP. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54:751–62.

    Article  CAS  Google Scholar 

  • Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922–5.

    Article  CAS  Google Scholar 

  • Rocca B, Martin C, Viviand X, Bidet PF, Saint-Gilles HL, Chevalier A. Comparison of four severity scores in patients with head trauma. J Trauma. 1989;29:299–305.

    Article  CAS  Google Scholar 

  • Rutledge R, Lentz CW, Fakhry S, Hunt J. Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma. 1996;41:514–22.

    Article  CAS  Google Scholar 

  • Starmark JE, Stålhammar D, Holmgren E. The Reaction Level Scale (RLS85). Manual and guide- lines. Acta Neurochir. 1988;91:12–20.

    Article  CAS  Google Scholar 

  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.

    Article  CAS  Google Scholar 

  • Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir. 1976;34:45–55.

    Article  CAS  Google Scholar 

  • Tude Melo JR, Di Rocco F, Blanot S, Oliveira-Filho J, Roujeau T, Sainte-Rose C, Duracher C, Vecchione A, Meyer P, Zerah M. Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale. Neurosurgery. 2010;67:1542–7.

    Article  Google Scholar 

  • White JR, Farukhi Z, Bull C, Christensen J, Gordon T, Paidas C, Nichols DG. Predictors of outcome in severely head-injured children. Crit Care Med. 2001;29:534–40.

    Article  CAS  Google Scholar 

  • Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University Clinic of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark

    Jacob Bertram Springborg

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  1. Jacob Bertram Springborg
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Correspondence to Jacob Bertram Springborg .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway

    Terje Sundstrøm

  2. Department of Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden

    Per-Olof Grände

  3. Department of Neurosurgery, Tampere University Hospital, Tampere, Finland

    Teemu Luoto

  4. Department of Neurosurgery, Odense University Hospital, Odense, Denmark

    Christina Rosenlund

  5. Department of Operation and Intensive Care, Halmstad Hospital, Halmstad, Sweden

    Johan Undén

  6. Department of Clinical Medicine K1, University of Bergen, Bergen, Norway

    Knut Gustav Wester

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Springborg, J.B. (2020). Primary Clinical Assessment. In: Sundstrøm, T., Grände, PO., Luoto, T., Rosenlund, C., Undén, J., Wester, K. (eds) Management of Severe Traumatic Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-39383-0_8

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  • DOI: https://doi.org/10.1007/978-3-030-39383-0_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-39382-3

  • Online ISBN: 978-3-030-39383-0

  • eBook Packages: MedicineMedicine (R0)

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