Collision of Priorities in Posttraumatic Coma and Suspected Multiple Injuries: A Prospective Multicenter Trial.

Area of Science:

• Neurosurgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Assessing patients with traumatic brain injury (TBI) and multiple injuries presents diagnostic and treatment prioritization challenges.
• Interdisciplinary teams must balance competing priorities in the initial management of comatose patients.

Purpose of the Study:

• To analyze the prioritization of diagnostic and surgical measures in comatose patients with suspected multiple injuries.
• To draw conclusions regarding optimal management strategies and prognostic indicators.

Main Methods:

• Prospective multicenter cohort study of 1,003 comatose patients with suspected multiple injuries.
• Analysis of diagnostic and surgical measures over a 6-month period, divided into early and late stages.
• Investigation of the prognostic value of the Glasgow Coma Scale (GCS) and the World Federation of Neurosurgical Societies grading scale.

Main Results:

• Intracranial hematoma removal and decompressive craniotomies were the most frequent early procedures (within 48 hours).
• Patient prognosis is significantly influenced by injury location, combination, and initial signs of brainstem dysfunction.
• The GCS demonstrated limited accuracy in predicting clinical outcomes.

Conclusions:

• Hospitals must have continuous neurosurgical services for comatose patients with multiple injuries due to frequent early intracranial operations.
• Urgent surgical decompression is crucial for favorable outcomes, tailored to the patient's neurological status.
• The GCS alone is insufficient for neurologic assessment and prognosis; brainstem dysfunction signals critical deterioration.