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Title
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Decision making in very severe traumatic brain injury (Glasgow Coma Scale 3-5) : a literature review of acute neurosurgical management
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Author
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Abstract
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| INTRODUCTION: Patients presenting with an early Glasgow Coma Scale (GCS) Score of 3-5 after blunt or penetrating skull-brain assaults are categorized as having sustained a very severe traumatic brain injury (vs-TBI). This category is often overlooked in literature. Impact on patients and families lives however is huge and the question "whether to surgically treat or not" frequently poses a dilemma to treating physicians. Little is known about mortality and outcome, compared to what is known for the group of severe TBI patients (s-TBI) (GCS 3-8). The main goal of this review was creating more awareness for the neurosurgical treatment of this patient group. EVIDENCE ACQUISITION: A literature search (2000-2017) was conducted discussing "severe TBI (GCS 3-8)", "(neuro) surgical management" and "outcome". Ultimately 45 out of 2568 articles were included for further analysis. EVIDENCE SYNTHESIS: Mortality rates and unfavorable outcome are high for s-TBI patients and as expected higher for vs-TBI patients. Mortality rates reach up to 100% for specific subgroups with GCS=3 and bilaterally fixed dilated pupils. Functional outcome was generally poor, but sometimes, although seldom, favorable in specific groups of vs-TBI patients after neurosurgical intervention. Factors like initial GCS, pupillary abnormalities and age seem to be associated with worse outcome. CONCLUSIONS: Overall this literature review showed high rates of unfavorable outcome and mortality for vs-TBI patients. However, some studies, reporting relatively low mortality rates, reported "good" outcome for specific groups of vs-TBI patients. It is concluded that clinical decision making, in particular those on treatment limitations, should never be taken based on the GCS alone. |
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Language
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English
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Source (journal)
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Journal of neurosurgical sciences. - Milano
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Publication
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Turin
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Edizioni minerva medica
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2018
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ISSN
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0390-5616
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DOI
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10.23736/S0390-5616.17.04255-2
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Volume/pages
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62
:2
(2018)
, p. 153-177
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ISI
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000445305500007
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Pubmed ID
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29125266
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Full text (Publisher's DOI)
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