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




Chico-Fernández M, Barea-Mendoza JA, Servià-Goixart L, Omarzabal-Zabala T, Quintana-Díaz M, González-Robledo J, Iglesias-Santiago A, Sánchez-Arguiano MJ, Pérez-Bárcena J, Llompart-Pou JA



UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain. Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain. Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain. Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain. Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain. Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain. Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain.



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.
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.
Conclusions. 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.


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