Journal of Trauma and Injury

Original Articles

Correlation between bispectral index values and the Glasgow Coma Scale in traumatic brain injury patients: a prospective observational study: Anjum H. Mujawar, Pradnya M. Bhalerao, Sujit J. Kshirsagar; J Trauma Inj. 2025;38(2):97-102. Published online June 30, 2025; DOI: https://doi.org/10.20408/jti.2025.0026

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Abstract PDF: Purpose
Traumatic brain injury (TBI) severity is typically assessed using the Glasgow Coma Scale (GCS). In contrast, the bispectral index (BIS) objectively evaluates a patient’s level of consciousness in an intensive care unit. The primary objective of this study was to evaluate the correlation between GCS and BIS values in TBI patients. Secondary objectives included determining the range of BIS scores corresponding to different levels of consciousness and assessing the correlation among mild, moderate, and severe TBI.
Methods
Sixty patients participated in a prospective observational study conducted at a government tertiary care facility. After obtaining a detailed history and performing a physical examination, each patient’s age, sex, intubation status, computed tomography brain findings, and vital signs were recorded. Subsequently, the patients’ GCS and BIS values were measured at 0, 6, 12, 18, and 24 hours. Quantitative data are presented as mean±standard deviation, while qualitative data are illustrated using frequency and percentage tables. Spearman correlation analysis was employed to evaluate the association.
Results
Spearman correlation analysis demonstrated a strong positive relationship between BIS and GCS at 0 hours (r=0.655, P<0.05), 6 hours (r=0.647, P<0.05), 12 hours (r=0.652, P<0.05), 18 hours (r=0.659, P<0.05), and 24 hours (r=0.648, P<0.05). Moreover, the mean BIS value decreased significantly with increasing severity of head injury.
Conclusions
Similar to the GCS, the BIS correlates with head injury severity and may serve as a complementary tool for predicting outcomes in TBI patients.; Summary

Validation of chest trauma scoring systems in polytrauma: a retrospective study with 1,038 patients in Korea: Hongrye Kim, Mou Seop Lee, Su Young Yoon, Jonghee Han, Jin Young Lee, Junepill Seok; J Trauma Inj. 2024;37(2):114-123. Published online May 9, 2024; DOI: https://doi.org/10.20408/jti.2023.0087

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Purpose
Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients.
Methods
Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma.
Results
In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5–15] vs. 15 [14–15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively)
Conclusions
Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.

Summary

Citations

Citations to this article as recorded by

Clinical prediction models for the management of blunt chest trauma in the emergency department: a systematic review
Ceri Battle, Elaine Cole, Kym Carter, Edward Baker
BMC Emergency Medicine.2024;[Epub] CrossRef

Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma: Jisoo Park, Taejin Park, Jung-In Ko, Woonhyung Yeo; J Trauma Inj. 2020;33(4):227-235. Published online December 31, 2020; DOI: https://doi.org/10.20408/jti.2020.0041

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Abstract PDF

Purpose

Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication.

Methods

In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined.

Results

The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score.

Conclusions

The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

Summary

Citations

Citations to this article as recorded by

The Glasgow Coma Scale: an international standard for education and practice with adults
Neal Cook, Ruth Trout, Catheryne Waterhouse, Mary Braine, Chris Barrett, Paul Brennan, Graham Teasdale, Ole Abildgaard Hansen, Valeria Caponnetto, Pedro Raúl Castellano Santana, Hilalnur Küçükakgün, Claire Lynch, Andrea Shepherd, Zeliha Tulek, Zoé Wahl
British Journal of Neuroscience Nursing.2025; 21(Sup1c): S1. CrossRef
Intoxication and Glasgow coma scale scores in patients with head trauma
Callie Pina, Catherine A. Marco
The American Journal of Emergency Medicine.2024; 80: 8. CrossRef
Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study
Navin S Arunachalam Jeykumar, Gopalakrishnan M Niban, Pandiyan Vadivel, Sumathy Masanam Kasi
Cureus.2024;[Epub] CrossRef

Comparison Prehospital RTS (Revised trauma score) with Hospital RTS in Trauma Severity Assessment: Seung Yeop Lee, Young Jin Cheon, Chul Han; J Trauma Inj. 2015;28(3):177-181. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.177

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Abstract PDF

PURPOSE
Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources.
METHODS
We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records.
RESULTS
There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS.
CONCLUSION
Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients.

Summary

Citations

Citations to this article as recorded by

Comparative Evaluation of Emergency Medical Service Trauma Patient Transportation Patterns Before and After Level 1 Regional Trauma Center Establishment: A Retrospective Single-Center Study
Hyeong Seok Lee, Won Young Sung, Jang Young Lee, Won Suk Lee, Sang Won Seo
Journal of Trauma and Injury.2021; 34(2): 87. CrossRef
Real-Time Monitoring Electronic Triage Tag System for Improving Survival Rate in Disaster-Induced Mass Casualty Incidents
Ju Young Park
Healthcare.2021; 9(7): 877. CrossRef

Value of Repeat Brain Computed Tomography in Children with Traumatic Brain Injury: Ho Jun Jo, Yong Su Lim, Jin Joo Kim, Jin Seong Cho, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee; J Trauma Inj. 2015;28(3):149-157. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.149

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2 Citations

Abstract PDF

PURPOSE
Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI.
METHODS
We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome.
RESULTS
A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group.
CONCLUSION
Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.

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Citations

Citations to this article as recorded by

Analysis of Computed Tomography Scans for Radiation Safety Management in the Republic of Korea
Min Young Lee, Ji Woo Kim, Ga Eun Oh, Geon Woo Son, Kwang Pyo Kim
Journal of Radiation Protection and Research.2024; 49(3): 141. CrossRef
Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury : Korean Neuro-Trauma Data Bank System (KNTDBS) 2010–2014
Hee-Won Jeong, Seung-Won Choi, Jin-Young Youm, Jeong-Wook Lim, Hyon-Jo Kwon, Shi-Hun Song
Journal of Korean Neurosurgical Society.2017; 60(6): 710. CrossRef

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