NeuroscienceThe epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3

- Severe TBI resulting from fall etiology increased by 59% (26%-41%, P = .001), whereas the severe TBI from vehicular injury did not change over time (49%-44%, P = .63). There were significant changes in the make-up of both the vehicular and fall population over time.
- Overall mortality with TBI and Glasgow Coma Scale 3 was 43% and did not differ by etiology. However, mortality from falls increased substantially from 25% to 63% (P < .001), whereas death from vehicular etiology remained statistically unchanged but with a downward trend.
- A key prognostic indicator of mortality for vehicular etiology was abnormal emergency department vital signs, increasing the odds of mortality 2.7-fold. On the contrary, mortality with a fall etiology was identical with normal and abnormal emergency department vital signs (48% for both).

PurposeTo characterize trends and prognosis of severe traumatic brain injury (TBI).MethodsThis 5-year multicenter retrospective study included patients with TBI and Glasgow Coma Scale of 3. We analyzed demographic and clinical characteristics and mortality using Pearson χ2 tests, Cochran-Armitage trend tests, and stepwise logistic regression. Analyses were stratified by vehicular and fall etiologies; other etiologies were excluded (24%).ResultsIncluded were 481 patients. Fall-related injuries increased 58% (P = .001) but vehicular etiology did not change (P = .63). The characteristics of the populations changed over time; with falls, the population became older and increasingly presented with normal vital signs, whereas with vehicular etiology, the population became younger, with more alcohol-related injury (P < .05 for all). Mortality from falls increased substantially from 25% to 63% (P < .001), whereas death from vehicular injures remained statistically unchanged but with a downward trend (50%-38%, P = .28). Predictors of mortality included injury severity and age at least 65 years for both groups. Additional variables that were prognostic were abnormal vital signs and subdural hematoma for vehicular injuries, and sex for fall injuries.ConclusionsThe epidemiology of severe TBI is changing. These epidemiologic data may be used for management and resource decisions, monitoring, and directing injury prevention measures.