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Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury
Published on: November 9, 2018
Glasgow coma scale-pupils at 24-hours as a reliable marker for extremely poor prognosis in traumatic brain injury - A
Pedro Fortes Osório Bustamante1, Roberta Muriel Longo Roepke2, Filipe Matheus Cadamuro3
1Department of Surgery, Division of General Surgery and Trauma, Hospital das Clinicas HCMFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
Objective:
Early prognosis determination after traumatic brain injury remains challenging, yet reliable early markers remain limited. A Glasgow Coma Scale-Pupil (GCS-P) score of 1, combining a GCS of 3 and bilaterally nonreactive pupils, has been proposed as a marker of catastrophic injury, although some patients may recover. The authors hypothesized that persistence of a GCS-P score of 1 after 24 h could predict poor prognosis.
Methods:
Descriptive study in a quaternary ICU in Brazil, including adult patients admitted between 2019 and 2025 with a pre-sedation GCS of 3 and bilaterally nonreactive pupils. Patients with unknown initial neurological status or a Marshall Computed Tomography Classification < 3 were excluded. Clinical characteristics, imaging findings, treatments, and outcomes were prospectively collected. The primary outcome was the Glasgow Outcome Scale-Extended (GOSE) at hospital discharge.
Results:
Among 2645 ICU admissions, 868 were due to TBI, and 49 met the inclusion criteria. Patients were predominantly young (median age 38-years), male (79.6%), and had high illness severity (median SAPS3 of 68). Most suffered blunt trauma, and nearly half underwent hemicraniectomy. All patients who persisted with a GCS-P score of 1 after 24-hours died during hospitalization (n = 36, 95% CI 90.3%-100%). Among those who improved their GCS-P score within 24-hours (n = 13), mortality was 54% (95% CI 25.1%-80.8%), and 31% (95% CI 9.1%-61.4%) recovered consciousness (GOSE > 2).
Conclusion:
Persistence of a GCS-P score of 1 after 24-hours is a highly reliable marker of poor prognosis in patients with severe TBI. These findings warrant external validation.
