• Fiona Lecky and David Yates.
• Derriford Hospital, Plymouth, Devon, United Kingdom.
• Emerg Med J. 2014 Sep 1;31(9):775-7.

Objectives & BackgroundThe relationship between age and presenting Glasgow Coma Scale (GCS) in adults with traumatic brain injury (TBI) has not so far been explored in detail. We have previously reported a trend for higher GCS in elderly patients presenting to our major trauma centre with isolated TBI compared with younger adults. The aim of this study was to confirm and define this relationship using a national trauma registry and to evaluate potential contributory factors. emermed;31/9/775-c/SA2EMERMED2014204221TB1T1sa2-EMERMED2014204221TB1 Table 1 Isolated Head AIS 3+ patients 1988-2014 N(total 13547) Adults*mean (95% CI), **median (IQR) N(total 2485) Elderly*mean (95% CI), **median (IQR) Male 10410 76.8% (76.1%-77.6%) 1368 55.1% (53.1%-57.0%) Age* *26.1 (15.9-42.0) *77.6 (71.0-84.0) ISS** **16 (13-25) **17 (16-25) AIS head** **4 (3-5) **4 (4-5) Presenting GCS** **14 (9-15) Underwentprocedure* 1681 12.4% (11.9%-13.0%) 200 8.0% (7.0%-9.1%) 30 day mortality* 1072 7.9% (7.5%-8.4%) 732 29.5% (27.7%-31.2%) Injury mechanism Blast 4 0.0% (0%-0.1%) 0 Blow 1862 13.7% (13.2%-14.3%) 53 2.1% (1.6%-2.7%) Other 1664 12.3% (11.7%-12.8%) 96 3.9% (3.1%-4.6%) Fall <2 m 2073 15.3% (14.7%-15.9%) 1244 50.1% (48.1%-52.0%) Fall >2 m 2382 17.6% (16.9%-18.2%) 524 21.1% (19.5%-22.7%) RTC 5553 41.0% (40.2%-41.8%) 567 22.8% (21.2%-24.5%) Stabbing/shooting 9 0.1% (0%-0.1%) 1 0.0% (0%-0.1%)MethodsThe Trauma Audit Research Network (TARN) database was interrogated to identify all adult (>16 years) cases of isolated TBI (Abbreviated Injury Score (AIS) 3 or greater for head with no AIS >3 in any other system) from 1988 to present. Cases were excluded if evidence of drug or alcohol intoxication, smoke or fume inhalation, psychiatric disturbance or traumatic asphyxia had been recorded. Demographic and detailed injury description data were recorded alongside GCS at Emergency Department presentation. Cases were categorised into adults (16-65 years) and elderly (>65 years). Presenting GCS was compared between the two groups for AIS head 3, 4 and 5. GCS data were not normally distributed therefore differences in GCS between groups were considered using two-way ANOVA performed on rank GCS. Sub-group analyses were performed comparing presenting GCS between adults and elderly in specific mechanisms of injury and for particular types of intracranial injury.Results16,032 cases were identified whose baseline characteristics are presented in table 1. Overall, presenting GCS differed significantly between the two groups at each level of AIS severity (figure 1), a finding that was consistently replicated for each common mechanism of injury (all p<0.01) (figure 2). This difference was not limited to any particular type of intracranial injury (figure 3). The inclusion of gender as an additional variable did not change the pattern of the results. emermed;31/9/775-c/EMERMED2014204221F1F1EMERMED2014204221F1 Figure 1 Graph of mean GCS by AIS grade all cases p<0.01. emermed;31/9/775-c/EMERMED2014204221F2F2EMERMED2014204221F2 Figure 2 Graph of mean GCS by AIS grade in most common mechanisms of injury. emermed;31/9/775-c/EMERMED2014204221F3F3EMERMED2014204221F3 Figure 3 Graph of mean GCS by AIS grade in specific intracranial injury types.ConclusionWe believe that this is the first study to demonstrate that elderly patients present with a higher GCS than younger adults for a given anatomical severity of TBI. This difference is not confined to any particular mechanism of injury nor any type of intracranial injury. These findings may have profound implications for prehospital trauma triage tools, outcome prediction methodologies and neurosurgical decision-making.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

1 keywords...

hide…