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GCS 15: when mild TBI isn't so mild.
Latha Ganti1,2, Tej Stead3, Yasamin Daneshvar4
1UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL USA.
Neurological Research and Practice
|December 16, 2020
Summary
Even mild traumatic brain injuries (TBIs) with a Glasgow Coma Scale (GCS) of 15 warrant neuroimaging due to frequent CT abnormalities. This highlights the limitations of GCS in classifying TBI severity.
Area of Science:
- Neuroscience
- Emergency Medicine
- Trauma Surgery
Background:
- Traumatic Brain Injury (TBI) classification relies on Glasgow Coma Scale (GCS).
- The mildest TBI category (GCS 15) is often presumed to have minimal injury.
- Characterizing patients with GCS 15 is crucial for understanding injury patterns and outcomes.
Purpose of the Study:
- To characterize patients presenting with the mildest form of traumatic brain injury (TBI), defined by a Glasgow Coma Scale (GCS) of 15.
- To identify predictors of adverse outcomes in this patient group.
- To evaluate the utility of neuroimaging in patients with GCS 15.
Main Methods:
- Observational cohort study of adult patients with TBI and GCS 15 at emergency department arrival.
- Data collection included demographics, injury mechanisms, symptoms (vomiting, LOC, AOC, PTA), pre-hospital and ED GCS, and CT scan results.
- Outcomes assessed: hospital admission, ICU admission, neurosurgical intervention, and in-hospital death.
Main Results:
- Loss of Consciousness (LOC), Alteration of Consciousness (AOC), and Post-Traumatic Amnesia (PTA) predicted hospital admission (p < 0.0001).
- ICU admission was associated with antiplatelet/anticoagulant use, PTA, LOC, and abnormal CT scans.
- Patients who died had intracranial hemorrhage on CT despite GCS 15, and were more likely to be on antiplatelet/anticoagulants and have experienced vomiting.
Conclusions:
- Neuroimaging is essential for all TBI patients, including those with GCS 15, as 10% in this cohort had abnormalities.
- GCS score alone is insufficient for classifying TBI severity, as even mild TBIs can present with significant CT findings.
- Findings underscore the need for thorough evaluation and imaging in patients with seemingly mild TBI.
