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1644 - Understanding Predictive Factors of Morbidity and Mortality in Traumatic Brain Injury Patients with a Glasgow Coma Scale of 3

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

CV

CRISTIAN VILLEGAS, MD

Resident
Loma Linda University Healtth
Loma Linda, California, United States

Co-Author(s)

AL

Alexandra Lang, BS

Student
Loma Linda University Health
Loma Linda, California, United States
SA

Sina Asaadi, MD

Resident
Loma Linda University Medical Center
Loma Linda, California, United States
AB

Alexander Bouterse, BS

Student
Loma Linda University Health
Loma Linda, California, United States
MT

Maryam Tabrizi, MD

Sub - Investigator
Loma Linda University Health
Loma Linda, California, United States
DT

Duc A. Tran, MD

Principle Investigator
Loma Linda University Health
Loma Linda, California, United States

Objectives: Due to poor perceived prognosis and futility, many clinicians and surrogate decision makers are electing to withdraw care in patients with severe traumatic brain injury (TBI). This study aims to improve upon the insufficient literature describing predictive factors of morbidity and mortality amongst TBI patients with a Glasgow Coma Scale (GCS) of 3.

Design: A retrospective cohort study of 68 patients with GCS of 3 with TBI presenting to a level 1 trauma center from January 2019 to January 2023 was performed. The data was obtained from its parent study titled “Reviving Hope: Do We Need a Fresh Approach to Traumatic Brain Injury Patients with a Glasgow Coma Scale Score of 3?” which served as a retrospective review of patients with a GCS of 3. Logistic regression was performed for outcomes such as care withdrawn, mortality, progression in brain injury, and neurosurgical intervention.

Results: Of the 68 patients included in this study, a mortality rate of 72.1% was observed with 33.8% of the deaths due to elective withdrawal of care. A minority of patients witnessed a progression of their intracranial findings (14.7%) as seen on head CT and no progression of neurological deficit was noted. There was a neurosurgical intervention rate of 16.2%. Logistic regression revealed age (p= 0.025, CI 0.005-0.076) served as positive predictor of withdrawal of care. In addition, Diffuse Axonal Injury (p=.01, CI 0.952-3.678) was as a positive predictor of mortality while brain herniation (p=.048, CI 0.015-2.875) and midline shift (p < .001, CI 0.121-0.407) were positive predictors of neurosurgical intervention.

Conclusions: This study highlights the importance of understanding prognostic indicators in patients with severe TBI and their potential role in impacting clinical decision making.