Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field.
OBJECTIVE
To investigate the outcome of brain trauma patients who had a Glasgow Coma Scale score (GCS) of 3 and bilateral fixed and dilated pupils (BFDP) in the field.


METHODS
Between January 2001 and December 2005, 13 European centres enrolled patients with severe brain trauma. Data sets of all patients who had a GCS of 3 as well as BFDP were analysed. Patients were classified according to the Glasgow Outcome Scale, 12 months after trauma as 'good' (Glasgow Outcome Scale of 5 or 4) or 'poor' functional recovery; relevant data for these two groups were compared. Variables that showed differences in univariate analyses (chi and Wilcoxon-Mann-Whitney tests) were then used as covariates in logistic regression models. A P value of less than 0.05 was considered significant.


RESULTS
Ninety-two (7.8%) of 1172 patients had a GCS of 3 and BFDP; eight had 'good', 84 had 'poor' recovery. We found no significant differences in sex (79% male), age (median 32 years), and trauma mechanisms. Trauma was significantly less severe, probability of survival significantly higher (0.48 vs. 0.23) in the 'good' group. Only one of 39 patients who had closed basal cisterns on the first computed tomography scan, and none of the patients with midline shift greater than 15 mm had good outcomes. Logistic regression revealed that age, trauma severity, and status of basal cisterns on the first computed tomography scan were the factors determining outcomes.


CONCLUSIONS
Patients with a GCS of 3 and BFDP in the field should be resuscitated aggressively, especially if the trauma seems to be not too severe.
Mauritz
Walter
W
Department of Anaesthesiology and Intensive Care Medicine, Trauma Hospital Lorenz Boehler, Vienna, Austria. walter.mauritz@igeh.org
Leitgeb
Johannes
J
Wilbacher
Ingrid
I
Majdan
Marek
M
Janciak
Ivan
I
Brazinova
Alexandra
A
Rusnak
Martin
M
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011681:Pupil Disorders / Q000209:etiology*; D012372:ROC Curve; D020127:Recovery of Function; D012151:Resuscitation; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods*