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IMPACT OF THE GLASGOW COMA SCALE AND INJURY SEVERITY SCALE ON TRIAGE OF THE ELDERLY TRAUMATIC HEAD INJURY BY EMERGENCY PHYSICIANS AND RURAL SURGEONS
T Wasfie, H Beck, V Labond, J Hella, E Pearson, K Barber
Ascension Genesys Hospital

Background
Current trauma activation guidelines do not address age as a risk factor when leveling trauma patients. Despite age having been established as a significant independent predictor of early mortality in trauma patients. Glasgow coma scale (GCS) and Injury Severity Scale (ISS) plays a major role in leveling trauma patients. We studied the above relationship in our elderly patients presenting. With traumatic head injury

Methods
Retrospective analysis of patients, who presented to the ED with traumatic head injury between 2017-2019. We classified the 467 patients in to two groups. Group A : 64 years and younger, and group B: 65 years and older. Their GCS, ISS, Age, sex, co-morbidity , and anticoagulant ,were abstracted. The primary outcome were mortality and morbidity. The groups were compared using an independent studentís t-test for continuous variables and Chi-square analysis for rate comparison. The Cox regression analysis was used to analyze differences in the outcome while adjusting for the above factors.

Results
There were 217 patients in group A, and 250 patients in group B, presented to ED with GCS of 14 or 15, and their ISS below 15. The mean ISS significantly differed between group A ( 11.76) vs (14.73) in group B (p=0.002) ,there were 153 patients in group A and 139 patients in group B who were exclusively analyzed for this study. The most common diagnosis in group A was cerebral concussion (69.9%) , while group B intracranial hemorrhages (48.8%). In the younger age group(A) , 54.2% were level I and II. And none needed surgical intervention , on the other hand 85.6% were level III and two went for emergency craniotomy. The mean Hospital and intensive care stay for group A ,were 2.08(+1.9) days and 0.37(+1.32) days respectively vs 4.16(+3.04) days and 2.37(+2.02) days for the elderly group B. Mortality in group A were zero and in group B 3.8%. Cox Regression analysis shows Age as an independent predictor of death ,as well as the length of stay.

Conclusion
Elderly patients presented to the ED with traumatic head injury with high GCS and low ISS should be triaged as a priority .


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