Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field

Objective To investigate the outcome of brain trauma patients who had a Glasgow Coma Scale score (GCS) of 3 and bilateral fixed and dilated pupils (BFDP) in the field. Methods Between January 2001 and December 2005, 13 European centres enrolled patients with severe brain trauma. Data sets of all patients who had a GCS of 3 as well as BFDP were analysed. Patients were classified according to the Glasgow Outcome Scale, 12 months after trauma as 'good' (Glasgow Outcome Scale of 5 or 4) or 'poor' functional recovery; relevant data for these two groups were compared. Variables that showed differences in univariate analyses (chi(2) and Wilcoxon-Mann-Whitney tests) were then used as covariates in logistic regression models. A P value of less than 0.05 was considered significant. Results Ninety-two (78%) of 1172 patients had a GCS of 3 and BFDP; eight had 'good', 84 had 'poor' recovery. We found no significant differences in sex (79% male), age (median 32 years), and trauma mechanisms. Trauma was significantly less severe, probability of survival significantly higher (0.48 vs. 0.23) in the 'good' group. Only one of 39 patients who had closed basal cisterns on the first computed tomography scan, and none of the patients with midline shift greater than 15 mm had good outcomes. Logistic regression revealed that age, trauma severity, and status of basal cisterns on the first computed tomography scan were the factors determining outcomes. Conclusion Patients with a GCS of 3 and BFDP in the field should be resuscitated aggressively, especially if the trauma seems to be not too severe. European Journal of Emergency Medicine 16:153-158 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.