@article{ref1,
title="Is it possible to recover from traumatic brain injury and a Glasgow coma scale score of 3 at emergency department presentation?",
journal="American journal of emergency medicine",
year="2018",
author="Sadaka, Farid and Jadhav, Amar and Miller, Melinda and Saifo, Ammar and O'Brien, Jacklyn and Trottier, Steven",
volume="36",
number="9",
pages="1624-1626",
abstract="INTRODUCTION: A Glasgow Coma Scale (GCS) score of 3 on presentation in patients with traumatic brain injury (TBI) portends a poor prognosis. Consequently, there is often a tendency to treat these patients less aggressively because of low expectations for a good outcome. <br><br>METHODS AND RESULTS: We performed a retrospective review of patients with TBI and a GCS score of 3. Patients were divided into 2 groups based on Glasgow Outcome Scale (GOS): Group 1 (GOS=1-3) and Group 2 (GOS=4-5). A total of 62 patients were included. The overall mortality rate was 80.6%. At 6-month, 9 patients (14.5%) achieved a GOS 4-5. Compared to Group 2 (n=9), Group 1 (n=53) had higher average APACHE IV score (104±19 vs 89±27, p=0.04), more patients with bilateral fixed pupils (59% vs 22%, p=0.04), and higher ICP burden (50±34 vs 0±0, p=0.0001). Using the CRASH calculator, the estimated mortality at 14days was 66% compared to actual mortality of 81%; difference of 15%, (p=0.05), and the estimated GOS 1-3 was 85.5% compared to actual of 85.5%, (p=1.0). <br><br>CONCLUSIONS: 14.5% of patients with TBI and a GCS of 3 at presentation achieved a good outcome at 6months, and 6.9% of patients with GCS of 3 and bilateral fixed pupils on presentation to the ED achieved a good outcome at 6months.<br><br>Copyright © 2018 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0735-6757",
doi="10.1016/j.ajem.2018.01.051",
url="http://dx.doi.org/10.1016/j.ajem.2018.01.051"
}