Using Glasgow Coma Score at Admission to Predict One Year Mortality in Injured Admitted to the Trauma Centre of a North Indian State Lacking an Organized System of Trauma Care

Abstract

Aim: To investigate whether Glasgow Coma Score at admission can be used to predict one year mortality in a resource constrained scenario lacking prehospital care. Study Design: Prospective observational study Place and Duration of Study: Study was conducted at the King George Medical University trauma centre between January 1st, 2010 to December 31st, 2010 Methodology: Information regarding factors known to affect mortality was recorded. Patients were followed up till death or for a period of one year since injury. Patients that died due to reasons other than injury and those with incomplete data sets were excluded from analysis. Three patients died due to reasons other than injury. Logistic regression, actuarial survival analysis, Cox proportionate Hazard model were used to identify predictors of one year mortality. Results: We enrolled 572 patients (478 males, 94 females, mean age 40.81±16.3 years). One hundred forty three patients died during follow up (140 due to injury and 3 due to other reasons). Thirty six patients had incomplete data sets. Kaplan Meir survival curve showed two distinct phase of mortality namely before and after 6th day of injury. Mortality within six days of injury was predicted by age, ISS, APTT, Glasgow Coma Score at admission and cervical spine injury. Mortality after 6th day was predicted by Glasgow Coma Score at the time of admission. Last death occurred 8 weeks after injury. Conclusion: Glasgow coma score at the time of admission is a valid predictor of one year mortality in trauma care systems lacking in pre-hospital care and an organized system of trauma care. Patients with low Glasgow Coma Score at admission continue to die 8 weeks after injury and therefore should be managed in the hospital for at least 8 weeks.