Classification of a traumatic brain injury: the Glasgow Coma scale is not enough.
BACKGROUND
Classifying the severity of a traumatic brain injury (TBI) solely by means of the Glasgow Coma scale (GCS) is under scrutiny, because it overlooks other important clinical signs. Clinicians treating patients with acute TBI are well placed to suggest which variables, in addition to the GCS, should concur in a new classification of TBI.


METHODS
In Italy, acute TBI patients are treated by anaesthetists, and so we asked them, in a questionnaire survey, to rate the weight they give to the GCS and to other clinical variables in their approach to TBI. Because sedation may underestimate GCS scores, we also inquired whether anaesthetists select sedatives that allow drug-free GCS scores. The questionnaire was distributed to 1334 anaesthetists attending courses on neurotrauma; the response rate was 63%.


RESULTS
Two thirds of the respondents believe that the definition of severe TBI should include, in addition to GCS scores, pupil reactivity to light and computer tomogram (CT) findings, the variables that guide Italian anaesthetists in TBI management. Most respondents (68.2%) administer sedation which allows prompt neurological evaluation and reliable GCS scoring. A minority of respondents (9.3%) withhold or antagonize sedation, delay tracheal intubation or allow patient-ventilator asynchrony.


CONCLUSIONS
Italian anaesthetists would welcome a definition of TBI severity that includes CT findings and pupil reactivity in addition to the GCS.
Chieregato
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A
UO Anestesia e Rianimazione, Rianimazione per la Traumatologia e le Neuroscienze, Ospedale Bufalini, Cesena, Italy. achiere@ausl-cesena.emr.it
Martino
C
C
Pransani
V
V
Nori
G
G
Russo
E
E
Noto
A
A
Simini
B
B
D000776:Anesthesiology; D001930:Brain Injuries / Q000145:classification* / Q000175:diagnosis; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007022:Hypotension / Q000175:diagnosis; D000860:Hypoxia / Q000175:diagnosis; D007558:Italy; D008027:Light; D009104:Multiple Trauma / Q000150:complications; D010808:Physical Examination; D012021:Reflex, Abnormal; D012025:Reflex, Pupillary / Q000187:drug effects / Q000528:radiation effects; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D006993:Hypnotics and Sedatives