title: The epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3.
abstract: To characterize trends and prognosis of severe traumatic brain injury (TBI).
  
  
  
  This 5-year multicenter retrospective study included patients with TBI and Glasgow Coma Scale of 3. We analyzed demographic and clinical characteristics and mortality using Pearson χ2tests, Cochran-Armitage trend tests, and stepwise logistic regression. Analyses were stratified by vehicular and fall etiologies; other etiologies were excluded (24%).
  
  
  
  Included were 481 patients. Fall-related injuries increased 58% (P=.001) but vehicular etiology did not change (P=.63). The characteristics of the populations changed over time; with falls, the population became older and increasingly presented with normal vital signs, whereas with vehicular etiology, the population became younger, with more alcohol-related injury (P<.05 for all). Mortality from falls increased substantially from 25% to 63% (P<.001), whereas death from vehicular injures remained statistically unchanged but with a downward trend (50%-38%, P=.28). Predictors of mortality included injury severity and age at least 65 years for both groups. Additional variables that were prognostic were abnormal vital signs and subdural hematoma for vehicular injuries, and sex for fall injuries.
  
  
  
  The epidemiology of severe TBI is changing. These epidemiologic data may be used for management and resource decisions, monitoring, and directing injury prevention measures.
authors.affiliation: Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075; Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113; Department of Trauma Research, St Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228; Department of Trauma Research, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907. Electronic address: ksalottolo@ampiopharma.com.
authors.forename: Kristin
authors.initials: K
authors.lastname: Salottolo
authors.affiliation: Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075; Trauma Services Department, Medical Center of Plano, 3901 W 15th St, Plano, TX 75075. Electronic address: matt.carrick@acutesurgical.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carrick
authors.affiliation: Intermountain Neurosurgery, 11700 W. 2nd Place, Lakewood, CO 80228; Trauma Services Department, St Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228. Electronic address: stewartlevy@centura.org.
authors.forename: A
authors.initials: A
authors.lastname: Stewart Levy
authors.affiliation: Trauma Services Department, Medical Center of Plano, 3901 W 15th St, Plano, TX 75075. Electronic address: brentandang@me.com.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Morgan
authors.affiliation: Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113; Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113. Electronic address: sue.slone@healthonecares.com.
authors.forename: Denetta S
authors.initials: DS
authors.lastname: Slone
authors.affiliation: Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075; Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113; Department of Trauma Research, St Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228; Department of Trauma Research, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907. Electronic address: dbaror@ampiopharma.com.
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003422:Critical Care / Q000639:trends; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Epidemiology; Glasgow Coma Scale; Mortality; Traumatic brain injury