title: Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3.
abstract: OBJECTIVE
  To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3.
  
  
  METHODS
  Trauma registry study.
  
  
  METHODS
  Level I urban trauma center.
  
  
  METHODS
  A total of 760 patients with head injury with an admission Glasgow Coma Scale score of 3. Analysis was performed in all patients and in only patients who reached the hospital alive and had no major extracranial injuries (exclusion of patients with a chest or abdominal Abbreviated Injury Score [AIS] >3).
  
  
  METHODS
  Stepwise logistic regression analysis was used to identify independent risk factors associated with mortality.
  
  
  RESULTS
  Blunt trauma accounted for 477 (63%) and penetrating trauma for 283 (37%) of the 760 head injuries. Penetrating trauma was significantly more likely to be associated with a lack of vital signs on admission (15% vs 9%; P = .03). Overall mortality was 76% (94% for penetrating injuries and 65% for blunt injuries; P<.001). Overall, 79% of patients had a head AIS of 4 or greater. Mortality in the subgroup was 64% (320/497) and was significantly higher in penetrating vs blunt trauma (89% vs 52%; P<.001). Penetrating trauma, high head AIS, hypotension on admission, and age older than 55 years were independent significant risk factors associated with mortality. Only 10% of the 177 survivors had good functional outcome at hospital discharge. Eighty-six patients (17% of those with vital signs on admission) became organ donors.
  
  
  CONCLUSIONS
  Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.
authors.affiliation: Division of Trauma, Surgical Intensive Care Unit, Los Angeles County, and University of Southern California Medical Center, Los Angeles, CA 90033, USA. demetria@usc.edu
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Eric
authors.initials: E
authors.lastname: Kuncir
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Kathy
authors.initials: K
authors.lastname: Alo
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis