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Age and pupil size: key predictors of mortality in traumatic brain injury patients with GCS 3
Tee-Tau Eric Nyam1, Kuan-Chi Tu1, Yun-Hsuan Kuo2
1Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan.
Insights
For severe traumatic brain injury (TBI) patients with a Glasgow Coma Scale (GCS) of 3, older age and larger pupil size significantly predict mortality. These factors are crucial for prognosis in TBI cases.
Area of Science:
- Neurology
- Trauma Surgery
- Critical Care Medicine
Background:
- Severe traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) of 3 indicates a critical condition with high mortality risk.
- Identifying prognostic factors is essential for effective clinical management and resource allocation in TBI patients.
Purpose of the Study:
- To investigate the relationship between mortality and clinical factors, specifically age and pupil size, in severe TBI patients (GCS=3).
- To determine the predictive value of age and pupil size on mortality outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 161 adult TBI patients with GCS score of 3, treated between 2010 and 2019.
- Spearman correlation and multiple logistic regression analyses were employed to identify predictors of mortality.
- Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses were used to determine optimal cut-off values.
Main Results:
- The overall mortality rate was 44.10%.
- Age and pupil size were identified as significant positive predictors of mortality.
- Patients with GCS 3 and pupils ≥4mm exhibited a 68.39% mortality rate, compared to 32.26% for those with pupils <4mm.
Conclusions:
- Age and pupil size are critical prognostic indicators for mortality in severe TBI patients with GCS=3.
- These findings offer valuable guidance for clinicians in assessing prognosis and managing TBI cases.
Abstract:
This study investigates the relationship between mortality and specific clinical factors in patients with severe traumatic brain injury (TBI) who present with a Glasgow Coma Scale (GCS) score of 3. Data from 161 adult patients were collected from the Chi-Mei Medical Center in Taiwan, spanning 2010 to 2019. The findings revealed an overall mortality rate of 44.10%, with significant predictors of mortality identified as age and pupil size. The Spearman correlation analysis showed that both age and pupil sizes were positively correlated with mortality rates. Multiple logistic regression confirmed age and left pupil size as strong predictors of mortality. Patients with GCS 3 and both unreactive pupils measuring 4 mm or more experienced the highest mortality rate of 68.39%, while those with pupils less than 4 mm had a lower mortality rate of 32.26%. The study determined optimal cut-off values for age and pupil size using ROC and AUC analysis, highlighting the significance of age in mortality predictions. These findings underscore the critical role of age and pupil size in the prognosis of TBI patients and provide valuable guidance for clinicians managing such cases.
