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09.02.2018 | Original Article | Ausgabe 3/2019

European Journal of Trauma and Emergency Surgery 3/2019

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

Zeitschrift:
European Journal of Trauma and Emergency Surgery > Ausgabe 3/2019
Autoren:
Jen-Fu Huang, Chun-Hsiang Ou Yang, Chih-Yuan Fu, Yu-Tung Wu

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.

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