Multiple trauma and shock vital signs as potential for improved outcome in patients with severe head trauma

To evaluate the prognostic factors in severe head trauma patients (Glasgow Coma Score (GCS) ≤ 8) with all trauma, including those with trunk injury as well as single severe head trauma (abbreviated injury scale (AIS) ≥ 3).

We included 152 consecutive patients with head trauma (AIS ≥ 3) and consciousness disorders (GCS ≤ 8) who were transported to our institute from January 2017 to October 2022. Data on the patients' background, vital signs at presentation, multiple trauma (AIS ≥ 3 in two or more locations), surgical intervention, and hematological findings were examined; a retrospective analysis was conducted with the modified Rankin Scale score after 3 months assigned as the primary outcome.

The patients' mean age was 57.6 ± 23.4 years (0-89), 49 patients (32.2%) had multiple trauma, and 25 patients (16.4%) had accompanying shock vital signs. In the multivariate analysis of prognosis, age (p = 0.0007) and D-dimer levels (p = 0.0007) were independent poor prognostic factors. On the contrary, patients with multiple trauma (p = 0.027) and shock vital signs at presentation (p = 0.037) had a significantly better prognosis. In the non-shock group, 97.6% (41/42) of patients aged ≥50 years and with D-dimer level of 40 μg/mL or higher had a poor prognosis after 3 months.

Advanced age and high D-dimer levels are important independent associated factors in patients with severe consciousness disorder associated with head trauma; meanwhile, the prognosis is more favorable in patients whose consciousness disorders are associated with multiple trauma or circulatory failure, indicating that rapid improvement of circulatory failure may lead to better outcomes.