title: Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention.
abstract: Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion.
  
  
  
  To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention.
  
  
  
  Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015.
  
  
  
  Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score.
  
  
  
  Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P < .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P < .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores.
  
  
  
  Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.
authors.affiliation: Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Ashkenazi
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: William P
authors.initials: WP
authors.lastname: Schecter
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel4Disaster Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Givon
authors.affiliation: Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Olsha
authors.affiliation: Emergency Surgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Turegano-Fuentes
authors.affiliation: Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alfici
authors.affiliation: Trauma and Emergency Surgery Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Hany
authors.initials: H
authors.lastname: Bahouth
authors.affiliation: Department of Surgery, HaEmek Medical Center, Afula, Ruth and Bruce Rappaport Medical School, Technion, Haifa, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.affiliation: Wolfson Medical Center, Holon, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Ben Ely
authors.affiliation: Trauma Unit, Ziv Medical Center, Zfat, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Braslavsky
authors.affiliation: Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Jeroukhimov
authors.affiliation: Trauma Unit, Poriya Medical Center, Tiberias, Israel.
authors.forename: Milad
authors.initials: M
authors.lastname: Qarawany
authors.affiliation: Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel14Bruce Rappaport Medical School, Technion, Haifa, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Kessel
authors.affiliation: Divison of Acute Care Surgery and Trauma, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Klein
authors.affiliation: Kaplan Medical Center, Rehovot, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Lin
authors.affiliation: Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
authors.affiliation: Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
authors.affiliation: Surgery Department, Barzilai Medical Center, Ashkelon, Israel.
authors.forename: Youri
authors.initials: Y
authors.lastname: Mnouskin
authors.affiliation: Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Avraham I
authors.initials: AI
authors.lastname: Rivkind
authors.affiliation: Trauma Unit, Soroka Medical Center, Beer-Sheva, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Shaked
authors.affiliation: The Yitzhak Rabin Trauma Division, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
authors.affiliation: Trauma Unit, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Stein
authors.affiliation: Trauma Unit, Galilee Medical Center, Nahariya, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001753:Blast Injuries / Q000175:diagnosis* / Q000601:surgery*; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000706:statistics & numerical data*; D005107:Explosions; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D007557:Israel; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D020380:Needs Assessment; D023481:Terrorism; D055815:Young Adult