The following is a summary of “Nuance and profound impact: Evaluating the effects of the unmet full coma scale in patients with mild subdural hemorrhage,” published in the March 2024 issue of Emergency Medicine by Chien, et al.

Patients presenting with subdural hemorrhage (SDH) and a Glasgow Coma Scale (GCS) score of 13–15 are typically categorized as having mild traumatic brain injury. For a study, researchers posit that patients without a maximum GCS score, specifically those with GCS scores of 13 and 14, may manifest poorer neurological outcomes.

A retrospective analysis was conducted on SDH patients with GCS scores ranging from 13 to 15 between January 1, 2019, and December 31, 2020. Outcomes were compared between patients with a maximum GCS score of 15 and those with either 13 or 14. Independent factors associated with neurological deterioration among patients with a GCS score 15 were assessed using multivariate logistic regression (MLR) analysis.

A total of 470 SDH patients with GCS scores between 13 and 15 were included in the study. Compared to patients with a maximum GCS score (N = 375), those in the GCS 13–14 group (N = 95) exhibited significantly higher rates of neurological deterioration (33.7% vs. 10.4%, P < 0.001) and neurosurgical interventions (26.3% vs. 16.3%, P < 0.024). Furthermore, the GCS 13–14 group had notably poorer prognoses than patients with a GCS score of 15 [mortality rate: 7.4% vs. 2.4%, P < 0.017; rate of impaired consciousness at discharge: 21.1% vs. 4.0%, P< 0.001; and rate of neurological disability at discharge: 29.5% vs. 6.9%, P < 0.001]. MLR analysis identified SDH thickness (odds ratio = 1.127, P = 0.006) as an independent risk factor for neurological disability at discharge in patients with a GCS score 15.

Among patients with mild traumatic brain injury due to SDH, those with GCS scores of 13–14 demonstrated poorer neurological outcomes compared to those with a maximum GCS score. Furthermore, SDH thickness was positively associated with neurological disability in patients with a maximum GCS score.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006526