Factors associated with death due to trauma in patients with a Glasgow Coma Scale score of 3 and bilateral fixed dilated pupils

OBJECTIVES

To compare patients with a Glasgow Coma Scale (GCS) score of 3 stratified according to pupillary reaction and to explore factors associated with in-hospital death in those with bilateral fixed dilated pupils.

MATERIAL AND METHODS

Prospective, observational, multicenter study. We included all patients with trauma and GCS scores of 3 admitted to the intensive care unit from March 2015 to December 2019. Factors associated with in-hospital mortality in the patients with bilateral dilated pupils were explored using multiple regression analysis.

RESULTS

Of the 933 patients included, 454 (48.7%) had responsive pupils, 201 (21.5%) had a single fixed dilated pupil, and 278 (29.8%) had bilateral dilation. Hospital mortality was high in all 3 groups: 32.5% in those with normal responsive pupils, 54.6% in those with a single unreactive pupil, and 91.0% in those with bilateral dilation. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. Twelve of the 26 patients (46.1%) with bilateral dilated pupils and GCS scores of 3 had GCS scores of 14 or 15 on discharge from the hospital.

CONCLUSION

The in-hospital mortality was 91% in this study of trauma patients with GCS scores of 3 and bilateral dilated pupils. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils.

Tranexamic acid in trauma patients in the emergency department: systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of tranexamic acid (TXA) in patients with severe trauma.

MATERIAL AND METHODS

MEDLINE, Embase, the Cochrane Library, the Web of Science, and ClinicalTrials.gov were searched to find relevant clinical trials published between January 1, 2008, and 1 August, 2018. The selected trials included trauma patients who received infusions of TXA within 8 hours. We extracted patient-related clinical variables and treatment variables. The main outcomes were mortality and functional status.

RESULTS

Five clinical trials were included in the systematic review. Four of them (20 697 patients) were included in the metaanalysis. We found that TXA versus placebo was associated with lower mortality (OR, 0.89 [95% CI, 0.83-0.96]; P = .004; 2 = 0%) and better functional status (OR, 0.60 [95% CI, 0.39-0.94]; P = .02; I2 = 0%). However, intensive care unit stays were longer in patients administered TXA (mean difference, 2.55 days [95% CI, 0.04-5.06 days]; P = .05; I2 = 0%).

CONCLUSION

ED infusion of TXA decreases mortality after severe trauma and improves patients' functional status.