title: Loss of Consciousness in Injuries of the Extremities is an Alert to a Higher Probability of Death.
abstract: BACKGROUND
  There are many published studies about loss of consciousness related to general trauma however works on loss of consciousness in respect to orthopedic injuries are scarce.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether loss of consciousness worsens the prognosis of patients with orthopedic injuries.
  
  
  METHODS
  A retrospective cohort study of orthopedic traumas was performed in the university Hospital of Base in São José do Rio Preto. All accident victims with injuries of the extremities classified as Score 3 or 4 by the Abbreviated Injury Scale (AIS) were included in this observational quantitative study. Patients with minor injuries and injuries that did not involve the extremities were not included. The association of loss of consciousness at the scene of the accident with evolution to death was investigated. The t-test, chi-squared and Fisher exact tests, and relative risk were used for statistical analysis. An alpha error of 5% (p-value ≤ 0.05) was considered statistically significant.
  
  
  RESULTS
  A total of 245 patients with ages between 13 and 98 years old and a mean of 45.4 years had extremity AIS scores of 3 or 4. Of these, significantly more men (170 - p< 0.001) suffered this type of injury than women (71). Thirty-six (14.94%) of these patients lost consciousness compared to 205 (85.06%) who did not lose consciousness. The total death rate in this group of patients was 5.39%; 9 (25%) of the 36 patients who lost consciousness and 4 (1.95%) of the 205 who did not lose consciousness died (Fisher exact test: p-value = 0.0001 and relative risk = 12,813 - 95% confidence index: 4,166 to 39,408).
  
  
  CONCLUSIONS
  Loss of consciousness in patients with orthopedic injuries of the extremities is associated to a higher death rate.
authors.affiliation: Department of Orthopedic and Traumatology in Medicine School of São Jose do Rio Preto, FAMERP, Brazil.
authors.forename: José Eduardo Arantes
authors.initials: JE
authors.lastname: Sanches
authors.forename: José Maria Pereira
authors.initials: JM
authors.lastname: de Godoy
authors.forename: André Luciano
authors.initials: AL
authors.lastname: Baitello
authors.forename: Alceu Gomes
authors.initials: AG
authors.lastname: Chueire
keywords: Injuries of the extremity; loss of consciousness.; trauma