Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT

• Published in: World journal of surgery Vol. 46; no. 12; pp. 2882 - 2889
• Main Authors: Li, Cheng-Yu, Chuang, Chi-Cheng, Chen, Ching-Chang, Tu, Po-Hsun, Hsu, Ting-An, Kuo, Yu-Chi, Liao, Chien-Hung, Hsieh, Chi-Hsun, Fu, Chih-Yuan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Brain; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnostic imaging; Cardiac Surgery; Computed tomography; Consciousness; Emergency medical care; Emergency medical services; Emergency Service, Hospital; General Surgery; Glasgow Coma Scale; Head injuries; Humans; Laboratory tests; Medicine; Medicine & Public Health; Original Scientific Report; Patients; Respiratory tract; Statistical analysis; Surgery; Thoracic Surgery; Tomography, X-Ray Computed; Traumatic brain injury; Unconsciousness; Unconsciousness - diagnostic imaging; Unconsciousness - etiology; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-022-06747-y

Background Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients’ characteristics. Methods From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness. Results A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85, p  = 0.017), early airway protection in ED (odds 25.02, p  = 0.018) and 72-h GCS score improvement by two points (odds 0.02, p  = 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to M 5 status and days to M 6 status (consciousness) was highly significant. Fewer days to M 5 status were highly associated with needing fewer days to regain consciousness. Conclusions For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with M 5 status.