Introduction: We sought to investigate discharge disposition of traumatic brain injury patients with the purpose of better understanding the spectrum of outcomes based on initial Glasgow Coma Scale (GCS) score.
Methods: The LAC+USC Trauma Registry was queried between 01/2015 and 06/2016 for discharge disposition of patients with initial GCS 3-9. GCS score was obtained from physician documentation in the emergency department. Patients were categorized into one of 11 dispositions ranging from Home to Morgue. Good, intermediate, and poor outcomes were defined home/home equivalent/rehab, long-term care facility, and death, respectively. Patients transferred to another acute facility were not included in the analysis.
Results: A total of 587 patients were studied, of whom 244 (42%) presented with GCS 3, 48 (8%) with GCS 4-5, 126 (22%) with GCS 6-7, and 171 (29%) with GCS 8-9. The most common dispositions were Home (44%) and Morgue (39%). Three hundred twelve patients (53%) had a good outcome, 44 patients (7%) had an intermediate outcome, and 231 patients (39%) had a poor outcome. Good outcomes were seen in 27% of GCS 3, 52% of GCS 4-5, 64% of GCS 6-7, and 83% of GCS 8-9 patients. Poor outcomes were seen in 68% of GCS 3, 41% of GCS 4-5, 25% of GCS 6-7, and 9% of GCS 8-9 patients.
Conclusions: In this patient population, initial GCS was predictive of discharge disposition. However, while the majority of patients with GCS 3 died, a significant minority experienced a good outcome. These data may better help stratify patient risk profiles at presentation for the purpose of counseling families. Further work is needed to better characterize neurologic salvageability at the time of presentation.
Patient Care: Knowledge of the spectrum of outcomes based on admission GCS will better inform clinical decision making and allow for improved conversations with families
Learning Objectives: By the conclusion of this session, participants should be able to: 1) cite rates of good and bad outcome for TBI patients in the study, 2) understand the relationship between increasing admission GCS and improved outcome at discharge