The reliability of the Glasgow Coma Scale in detecting traumatic brain injury: The continuous effect of age

Background: Recent studies noted the limited applicability of Glasgow Coma Scale (GCS) for elderly patients with Traumatic Brain Injury (TBI). However, the dichotomic distinction between "elderly" and "non-elderly" does not cover the full span of influence of age on GCS presentation.Objective: To analyze the influence of age on GCS scores of patients with isolated TBI.Methods: A retrospective study of 18,534 patients hospitalized due to isolated TBI recorded in the Israeli National Trauma Registry in 1997-2017. The GCS scores were compared between four age-groups: 20-44, 45-64, 65-74 and 75+ years old. Additional factors included patient's sex, Abbreviated Injury Scores (AIS) and injury circumstances.Results: GCS scores increased continuously with age at all AIS levels. The trend was significant even after adjustment for patient's sex and injury circumstances. The angle of the trend was different in various injury circumstances, with GCS scores of victims of Road Traffic Accidents sharply increasing after age of 44 and that of the patients hospitalized after falling from own height surging after age of 64.Conclusions: Screening procedures for patients with TBI should give a greater weight to the actual age of adults, as well as to the circumstances of their injury.