NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 8 - Head injury managementAssessment of neurological functionon admissionFigure 35 shows the fi rst documented hospital GCS in thegroup of patients who had suffered a head injury.From Figure 35 it can be seen that 91 patients had minorhead injury (GCS 15), 99 had mild head injury (GCS 13-14), 63 had moderate head injury (GCS 9-12) and 215had severe head injury (GCS 3-8). Of these, 100 were fi rstassessed to be completely unresponsive (GCS 3). For theremaining 25 patients a GCS was not documented.The 72 hour mortality rate for each group is shown in Table74. The group of patients with GCS 3 had a much worseoutcome. It is well known that initial GCS is an independentpredictor of outcome.Table 74. Mortality rate by Glasgow Coma ScoreGlasgowComa Score Alive Deceased Total%Mortality03 51 49 100 49.004-08 98 17 115 14.809-12 56 7 63 11.113-14 97 2 99 2.015 87 4 91 4.4Subtotal 389 79 468 16.9Not recorded 17 8 25 32.0Total 406 87 493 17.6Figure 35. First hospital Glasgow Coma Score measurement in the head injury group120Number of patients10080604020015141312111009Glasgow Coma Score080706050403Not recorded92