TY  - JOUR
PY  - 2023//
TI  - Nuance and profound impact: evaluating the effects of the unmet full coma scale in patients with mild subdural hemorrhage
JO  - American journal of emergency medicine
A1  - Chien, Shuo-Chi
A1  - Kang, Shih-Ching
A1  - Tu, Po-Hsun
A1  - Chen, Ching-Chang
A1  - Tee, Yu-San
A1  - Liao, Chien-Hung
A1  - Chuang, Chi-Cheng
A1  - Fu, Chih-Yuan
SP  - 60
EP  - 65
VL  - 77
IS  - 
N2  - INTRODUCTION: Patients with subdural hemorrhage (SDH) and a Glasgow Coma Scale (GCS) score of 13-15 are typically categorized as having mild traumatic brain injury. We hypothesize that patients without a maximum GCS score - specifically, patients with GCS scores of 13 and 14 - may exhibit poorer neurological outcomes. <br><br>METHOD: Between January 1, 2019, and December 31, 2020, SDH patients with GCS scores ranging from 13 to 15 were retrospectively studied. We compared outcomes between patients with a maximum GCS score of 15 and those with scores of either 13 or 14. Independent factors associated with neurological deterioration among patients with a GCS score of 15 were evaluated using multivariate logistic regression (MLR) analysis. <br><br>RESULTS: During the study period, 470 patients with SDH and GCS scores between 13 and 15 were examined. Compared to patients with a maximum GCS score (N = 375), those in the GCS 13-14 group (N = 95) showed significantly higher rates of neurological deterioration (33.7% vs. 10.4%, p value <0.001) and neurosurgical interventions (26.3% vs. 16.3%, p value <0.024). Moreover, the GCS 13-14 group had a significantly poorer prognosis than patients with a GCS score of 15 [mortality rate: 7.4% vs. 2.4%, p value <0.017; rate of impaired consciousness at discharge: 21.1% vs. 4.0%, p value <0.001; and rate of neurological disability at discharge: 29.5% vs. 6.9%, p value <0.001]. The MLR analysis revealed that SDH thickness (odds ratio = 1.127, p value = 0.006) was an independent risk factor for neurological disability at discharge in patients with a GCS score of 15. <br><br>CONCLUSION: Among SDH patients with mild TBI, those with GCS scores of 13-14 exhibited poorer neurological outcomes than those with a maximum GCS score. The thickness of the SDH is positively associated with neurological disability in SDH patients with a maximum GCS score.<p />  <p>Language: en</p>
LA  - en
SN  - 0735-6757
UR  - http://dx.doi.org/10.1016/j.ajem.2023.11.038
ID  - ref1
ER  -