Outcome Of Multiple Trauma Patients Research Articles

Effect of Implementation of the Rapid Response Nursing Team On Outcome Multiple Trauma(Head Trauma And Penetrate Trauma): A clinical trial

Background and Objective: Trauma patients admitted to the emergency department are exposed to the risk of clinical conditions and care disorders, which require careful examination and appropriate measures to prevent care disorders and risky situations. The present study aimed to determine the effect of the implementation of the rapid response nursing team on the outcome of multiple trauma patients (head trauma and open trauma) referred to the emergency department. Materials and Methods: This quasi-experimental intervention research was carried out by This semi-experimental interventional research by the rapid response nursing team with the presence of two team members in each shift in the Emergency Department of Taleghani Medical Education Center in Kermanshah on 280 patients referred to the emergency department by non-random allocation method in two groups (control: 140, intervention: 140). In the control group, patients were evaluated and cared for according to the routine of the emergency department. In the intervention group, the rapid response nursing team was put into action. The patients who met the inclusion criteria were accurately triaged and leveled upon arrival. Thereafter, immediately after being admitted to the emergency room, according to priority and level determination, all admitted patients were evaluated and monitored again in terms of consciousness level, vital signs, and clinical status in short rounds. Patients with a low triage level and the need for special care were subjected to continuous monitoring and necessary measures in a timely and fast manner until the final determination. The outcome and results of the measures were recorded for both groups. A researcher-made data collection form was used to collect data. In the end, the data were analyzed using SPSS software (version 25). To compare the quantitative and qualitative outcomes of the two control and intervention groups, independent t-tests and chi-square tests were used, respectively. Results: There was a significant relationship between the establishment of a rapid response nursing team and the outcome of multiple trauma patients (P=0.027). More than twice as many patients in the control group as in the intervention group were transferred to the special ward (P=0.010). The triage level of patients in the intervention group increased significantly (P<0.001). The length of stay of patients in the emergency department decreased (P<0.001). In the intervention group, the success rate of code 99 increased significantly (P=0.015). Among the other study results, we can mention a reduction in mortality and code 99 and an increase in the discharge rate. Conclusion: Considering the favorable effects of the rapid response nursing team on the rate of death, cardio-respiratory arrests, and unwanted consequences, these consequences can be controlled by deploying this team in emergency centers.

C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients.

C-reactive protein (CRP)/albumin ratio (CAR) is a new inflammation-based index for predicting the prognosis of various diseases. The CAR determined on admission may help to predict the prognostic value of multiple trauma patients. A total of 264 adult patients with severe multiple trauma were included for the present retrospective study, together with the collection of relevant clinical and laboratory data. CAR, CRP, albumin, shock index and ISS were incorporated into the prognostic model, and the receiver operating characteristic (ROC) curve was drawn. Then, the shock index for patients with different levels of CAR was analyzed. Finally, univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients. A total of 36 patients had poor survival outcomes, and the mortality rate reached 13.6%. Furthermore, after analyzing the shock index for patients with different levels of CAR, it was revealed that the shock index was significantly higher when CAR was ≥4, when compared to CAR <2 and 2≤ CAR <4, in multiple trauma patients. The multivariate logistic analysis helped to identify the independent association between the variables CAR (P=0.029) and shock index (P=0.019), and the 28-day mortality of multiple trauma patients. CAR is higher in patients with severe multiple trauma. Furthermore, CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients. The shock index was significantly higher when CAR was ≥4 in multiple trauma patients.

Diagnostic value of serum lactate as a predictor and early outcome in multiple trauma patients

Diagnostic value of serum lactate as a predictor and early outcome in multiple trauma patients

Predictive value of serum amylase level in outcome of multiple trauma patients

Introduction: The early detection of injury in multiple trauma patients can lead to decreased mortality, length of stay, and improved clinical status of the patient. It is shown that there is a relation between increased level of serum amylase and pancreatic injury in trauma patients. The aim of this study is to evaluate serum amylase level in hospital outcomes of patients with abdominal blunt trauma. Methods: This study was a cross-sectional survey that was conducted at the emergency room of Imam Reza (AS) Medical and Educational Center in Tabriz, Iran, during a year (April 2014-April 2015) on 101 patients with blunt abdominal trauma. Serum amylase levels were measured 6 hours after injury. The outcome of patients during hospitalization including the need for laparotomy and mortality were followed. Data were analyzed by SPSS software. P < 0.050 was considered significant. Results: A significant relationship between elevated serum amylase level by laparotomy and mortality was observed (P < 0.001). 15 patients had serum amylase higher than 100 U/L. All patients with abnormal serum amylase died. Conclusion: Determination of serum amylase level can be valuable in the prognosis of patients with blunt abdominal trauma, especially in determining mortality and proceed to laparotomy. However, studies with larger research community are required to investigate the precise role of amylase in the diagnosis and prognosis of patients with blunt abdominal trauma.

Factors related to sepsis and outcome in multiple trauma patients

The outcome of multiple trauma patients is related to a number of diagnostic and therapeutic interventions during hospitalization. ICU patients with severe trauma are susceptible to sepsis leading to poor outcome. Factors associated with the occurrence of sepsis and the outcome of these patients were investigated.

Relationship of emergency department length of stay with outcome of multiple trauma patients admitted to ICU

Objective To evaluate the relationship between emergency department length of stay (EDLOS) and outcome of multiple trauma patients in ICU.Methods A retrospective cohort study was performed in multiple trauma patients admitted from the emergency department to ICU during 2010.Patients' data were recorded,including demographic information (gender,age,etc.),characteristics of injury (injury causes,diagnosis,ISS,GCS,emergency operation rate,type of operation),and outcome (inhospital mortality,length of ICU stay,total length of hospital stay,expenditure).Patients were assorted into delayed group (EDLOS ＞ 6 h) and non-delayed group (EDLOS ≤ 6 h),then demographic information,characteristics of injury,and outcome were compared between the two groups.Multivariate Logistic and linear regression analyses were performed to identify the correlation between EDLOS and outcome for all patients and for those with and without emergency operation.Results A total of 476 patients aged (47.5 ± 16.0) years were enrolled in the study and male patients accounted for 73.5％.Median ISS was 29 points (interquartile range,22-34 points),median EDLOS was 4.0 hours (interquartile range,2.8-6.4 hours),and inhospital mortality was 9.2％.Delayed (n =135) and non-delayed (n =341) groups were similar in age,gender,ISS,inhospital mortality (13.3％ vs 7.6％),length of ICU stay,and total length of hospital stay (P ＞ 0.05).Multivariate analysis demonstrated prolonged EDLOS increased inhospital mortality (OR=3.19,95％ CI 1.28-7.95,P ＜ 0.05),especially in patients without emergent operation (OR =4.01,95％ CI 1.31-12.27,P ＜ 0.05).However,prolonged EDLOS produced no effect on mortality in patients with emergent operation (OR =1.72,95％ CI 0.79-3.43,P ＞0.05),length of ICU stay,total length of hospital stay,and expenditure.Conclusion Prolonged EDLOS increases mortality of multiple trauma patients admitted to ICU,especially in patients without emergency operation,thus rapid transportation of these patients from emergency room to ICU will improve the outcome. Key words: Multiple trauma; Outcome; Emergency department length of stay

Surgical strategies in polytraumatized patients with femoral shaft fractures – Comparing a German and an Australian level I trauma centre

BackgroundFemoral shaft fractures are one of the most common injuries in multiple trauma patients. Due to their prognostic relevance, there is an ongoing controversial discussion as to the optimal treatment strategy in terms of Damage Control Orthopaedics (DCO) and Early Total Care (ETC). We aimed to describe the differences in fracture management and clinical outcome of multiple trauma patients with concomitant femoral shaft fractures treated at a German and an Australian level I trauma centre using the same inclusion criteria. MethodsPolytraumatized patients (ISS≥16) with a femoral shaft fracture aged≥16 years treated at a German and an Australian trauma centre between 2003 and 2007 were included. According to ETC and DCO management principles, we evaluated demographic parameters as well as posttraumatic complications and clinical outcome. ResultsSeventy-three patients were treated at the German and 134 patients at the Australian trauma centre. DCO was performed in case of increased injury severity in both hospitals. Prolonged mechanical ventilation time, and length of ICU and hospital stay were demonstrated in DCO treatment regardless of the trauma centre. No differences concerning posttraumatic complications and survival were found between both centres. Survival of patients after DCO was similar to those managed using ETC despite a greater severity of injury and lower probability of survival. There was no difference in the incidence of ARDS. DCO was, however, associated with a greatly increased length of time on mechanical ventilation and length of stay in the ICU. ConclusionWe found no differences concerning patient demographics or clinical outcomes in terms of incidence of ARDS, MODS, or mortality. As such, we propose that comparability between German and Australian trauma populations is justified. Despite a higher ISS in the DCO group, there were no differences in posttraumatic complications and survival depending on ETC or DCO treatment. Further research is required to confirm whether this is the case with other countries, too.

Quality improvement in trauma care.

Improvement of quality in the care of multiple trauma patients is an ongoing issue at the various setting (e.g., prehospital setting, emergency room, surgery, intensive care, and rehabilitation). We have recently published a variety of issues focusing on this field, and particularly on quality control in trauma registries [1]. Trauma registries around the world are currently in deep discussions aimed at identifying common definitions and quality parameters, and we are curious to see the first results of those discussions. In this issue, we focus on quality improvement of prehospital trauma care and possible structural changes in the future. In addition, we look at diagnostic approaches during initial emergency room care. Aubuchon et al. [2] from the Netherlands compared the prehospital care received by patients with severe traumatic brain injury today with that provided twenty years ago and found similar outcomes, despite the fact that the time at each scene had changed. Today, the time at the scene is almost four times as long as it was twenty years ago. This unexpected result demonstrates that traumatic brain injury remains one of the most challenging diagnoses to improve in the future. In this respect, Lansik and Leenen [3] performed a very thorough review of polytrauma care in the Netherlands. They came up with the concept that most severely injured patients would optimally be concentrated in high-volume trauma centers, including a well-organized prehospital system (e.g., helicopter, emergency physicians). Such centers could work closely with level II and III centers, allowing a well-defined rescue system. Upon arrival at a trauma center, various well-defined diagnostic procedures take place according to the guidelines for trauma care (e.g., the updated S3 guideline in Germany: http://www.awmf.org/leitlinien/detail/ll/012019.html). Ultrasound is one of the procedures that is performed within the first few minutes after arrival [4]. While surgeons perform FAST (focused abdominal ultrasound in trauma) in most countries, radiologists are in charge of this in some settings. Tajoddini et al. [5] compared the quality of ultrasound performed by these two groups of physicians in cases of blunt abdominal trauma in a prospective manner. They demonstrated that both groups provided comparable diagnostic specificities considering the requirements of the emergency setting. In addition to ultrasound, CT scanning has found widespread use for the primary diagnosis of multiple trauma patients, leading to a better outcome [6]. However, the hazards of radiation need to be discussed, and further improvements in CT scanning technology and protocols are on the way. Kepros et al. [7] reviewed the residual risks of ionizing radiation very thoroughly with respect to trauma patient care. Accordingly, further prospective studies are warranted in order to determine the optimal application of this helpful procedure. Lastly, a well-performed study by Dubendorfer et al. [8] from Switzerland prospectively evaluated the role of serial lactate levels in patients with and without traumatic brain injury. They demonstrated that lactate is a strong indicator of the development of sepsis as well as outcome in multiple trauma patients. Lactate was less relevant in isolated traumatic brain injury patients, but the SOFA organ failure score differentiated between survivors and non-survivors following isolated traumatic brain injury. Overall, outcome of trauma care has substantially improved during the last decade, due to various I. Marzi (&) Department of Trauma Surgery, University Hospital, 60590 Frankfurt, Germany e-mail: marzi@trauma.uni-frankfurt.de

Impact of the Body Mass on Complications and Outcome in Multiple Trauma Patients: What Does the Weight Weigh?

Obesity is known as an independent risk factor for various morbidities. The influence of an increased body mass index (BMI) on morbidity and mortality in critically injured patients has been investigated with conflicting results. To verify the impact of weight disorders in multiple traumatized patients, 586 patients with an injury severity score >16 points treated at a level I trauma center between 2005 and 2011 were differentiated according to the BMI and analyzed regarding morbidity and outcome. Plasma levels of interleukin- (IL-) 6 and C-reactive protein (CRP) were measured during clinical course to evaluate the inflammatory response to the “double hit” of weight disorders and multiple trauma. In brief, obesity was the highest risk factor for development of a multiple organ dysfunction syndrome (MODS) (OR 4.209, 95%-CI 1.515–11.692) besides injury severity (OR 1.054, 95%-CI 1.020–1.089) and APACHE II score (OR 1.059, 95%-CI 1.001–1.121). In obese patients as compared to those with overweight, normal weight, and underweight, the highest levels of CRP were continuously present while increased systemic IL-6 levels were found until day 4. In conclusion, an altered posttraumatic inflammatory response in obese patients seems to determine the risk for multiple organ failure after severe trauma.

Liver cirrhosis but not alcohol abuse is associated with impaired outcome in trauma patients – A retrospective, multicentre study

IntroductionLiver cirrhosis has been shown to be associated with impaired outcome in patients who underwent elective surgery. We therefore investigated the impact of alcohol abuse and subsequent liver cirrhosis on outcome in multiple trauma patients. Materials and methodsUsing the multi-centre population-based Trauma Registry of the German Society for Trauma Surgery, we retrospectively compared outcome in patients (ISS≥9, ≥18) with pre-existing alcohol abuse and liver cirrhosis with healthy trauma victims in univariate and matched-pair analysis. Means were compared using Student's t-test and analysis of variance (ANOVA) and categorical variables using χ2 (p<0.05=significant). ResultsOverall 13,527 patients met the inclusion criteria and were, thus, analyzed. 713 (5.3%) patients had a documented alcohol abuse and 91 (0.7%) suffered from liver cirrhosis. Patients abusing alcohol and suffering from cirrhosis differed from controls regarding injury pattern, age and outcome. More specific, liver cirrhotic patients showed significantly higher in-hospital mortality than predicted (35% vs. predicted 19%) and increased single- and multi-organ failure rates. While alcohol abuse increased organ failure rates as well this did not affect in-hospital mortality. ConclusionsPatients suffering from liver cirrhosis presented impaired outcome after multiple injuries. Pre-existing condition such as cirrhosis should be implemented in trauma scores to assess the individual mortality risk profile.

Acute management and outcome of multiple trauma patients with pelvic disruptions.

IntroductionData on prehospital and trauma-room fluid management of multiple trauma patients with pelvic disruptions are rarely reported. Present trauma algorithms recommend early hemorrhage control and massive fluid resuscitation. By matching the German Pelvic Injury Register (PIR) with the TraumaRegister DGU (TR) for the first time, we attempt to assess the initial fluid management for different Tile/OTA types of pelvic-ring fractures. Special attention was given to the patient's posttraumatic course, particularly intensive care unit (ICU) data and patient outcome.MethodsA specific match code was applied to identify certain patients with pelvic disruptions from both PIR and TR anonymous trauma databases, admitted between 2004 and 2009. From the resulting intersection set, a retrospective analysis was done of prehospital and trauma-room data, length of ICU stay, days of ventilation, incidence of multiple organ dysfunction syndrome (MODS), sepsis, and mortality.ResultsIn total, 402 patients were identified. Mean ISS was 25.9 points, and the mean of patients with ISS ≥16 was 85.6%. The fracture distribution was as follows: 19.7% type A, 29.4% type B, 36.6% type C, and 14.3% isolated acetabular and/or sacrum fractures. The type B/C, compared with type A fractures, were related to constantly worse vital signs that necessitated a higher volume of fluid and blood administration in the prehospital and/or the trauma-room setting. This group of B/C fractures were also related to a significantly higher presence of concomitant injuries and related to increased ISS. This was related to increased ventilation and ICU stay, increased rate of MODS, sepsis, and increased rate of mortality, at least for the type C fractures. Approximately 80% of the dead had sustained type B/C fractures.ConclusionsThe present study confirms the actuality of traditional trauma algorithms with initial massive fluid resuscitation in the recent therapy of multiple trauma patients with pelvic disruptions. Low-volume resuscitation seems not yet to be accepted in practice in managing this special patient entity. Mechanically unstable pelvic-ring fractures type B/C (according to the Tile/OTA classification) form a distinct entity that must be considered notably in future trauma algorithms.

Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients

IntroductionAccidental hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of accidental hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. Patients and methodsInclusion criteria for patients in this retrospective study (2005–2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6h after the accident. Accidental hypothermia was defined as body temperature less than 35°C measured within 2h after admission, but always before first surgical procedure in the operation theatre. The association between accidental hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ2-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p<0.05. Results310 multiple trauma patients were enrolled in the present study. Patients’ mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of accidental hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between accidental hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, hypothermia failed to be an independent risk factor for mortality in multivariate analysis. ConclusionsAccidental hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of hypothermia. Furthermore, hypothermia was not shown to be an independent risk factor for posttraumatic complications.

Comparison of Different Thoracic Trauma Scoring Systems in Regards to Prediction of Post-Traumatic Complications and Outcome in Blunt Chest Trauma

As accurate assessment of thoracic injury severity in the early phase after trauma is difficult, we compared different thoracic trauma scores regarding their predictive ability for the development of post-traumatic complications and mortality. Two hundred seventy-eight multiple trauma patients (ISS ≥ 16) age > 16 y with severe blunt chest trauma (AIS(chest) ≥ 3) admitted between 2000 and 2009 to Level I Trauma center were included. Exclusion criteria were severe traumatic brain injury (AIS(head) ≥ 3) and penetrating thoracic trauma. The association between AIS(chest), Pulmonary Contusion score (PCS), Wagner-score and Thoracic Trauma Severity score (TTS), and duration of ventilation, length of ICU stay, development of post-traumatic complications, and mortality was investigated. Statistical analysis was performed with χ(2)-test, ANOVA, logistic regression, and receiver operating characteristic (ROC) curve. Patients' mean age was 42.7 ± 17.0 y, the mean injury severity score was 28.7 ± 9.3 points. Overall, 60 patients (21.6%) developed ARDS, 143 patients (51.4%) SIRS, 110 patients (39.6%) sepsis, and 36 patients (13.0%) MODS. Twenty-two patients (7.9%) died. Among the examined thoracic trauma scores only the TTS was an independent predictor of mortality. With the TTS showing the best prediction power, the TTS, PCS, and Wagner-score were independent predictors of ventilation time, length of ICU stay, and the development of post-traumatic ARDS and MODS. Thoracic trauma scores combining anatomical and physiologic parameters like the TTS seem to be most suitable for severity assessment and prediction of outcome in multiple trauma patients with concomitant blunt chest trauma.

Immunomodulation in Polytrauma and Polymicrobial Sepsis - Where Do We Stand?

Due to improved treatment strategies mortality in multiple trauma patients has been decreased over the last decades. However, posttraumatic complications like sepsis and subsequent multiple organ dysfunction syndrome (MODS) remain a major problem on intensive care units following major trauma. The clinical course after multiple trauma depends on the balance or imbalance of the pro- and anti-inflammatory immune response. The predominance of the proinflammatory response leads to the "Systemic Inflammatory Response Syndrome" (SIRS), whereas the "Compensatory Anti-inflammatory Response Syndrome" (CARS) might result in immune suppression with an enhanced risk for infectious complications. Both, SIRS and CARS, play a pivotal role in the development of sepsis and the "Multiple Organ Dysfunction Syndrome" (MODS). A gender dimorphism in the host response after multiple trauma and sepsis has already been described. In experimental as well as clinical studies, a protective effect of female sex hormones and precursors like androstenediol has been revealed. Moreover, blockade of androgen receptors and the inhibition of dihydrotestosterone (DHT) synthesis were shown to provide beneficial effects on the immune response. Beside sex hormones, modulation of the Toll Like Receptor (TLR) pathway by macrophage-activating lipopeptide-2 (MALP-2) has sufficiently been described. Furthermore, hydrogen sulfide (H₂S) and substance P have recently been revealed important for proinflammatory action in animal models of inflammation. Thus, these agents might be potential candidates for new treatment strategies in septic patients in order to improve the still unsatisfactory outcome of multiple trauma patients. If applicable, patents of each described agent are provided within the text.

Alcohol and multiple trauma—is there an influence on the outcome?

A relevant number of trauma patients are intoxicated with alcohol at admission in trauma centers. Meanwhile, some studies provide data suggesting a profound influence of ethanol on the posttraumatic clinical course; others could not confirm these findings. Knowledge of the influence of ethanol in a multiple trauma cohort is lacking. Therefore, we performed a retrospective outcome study of initially intoxicated multiple trauma patients in a German level-1 trauma center. Patients with an Injury Severity Score greater than or equal to 16 and aged 16–65 years were included in our study. Ventilation time, duration of intensive care unit treatment, the course of cytokines, and the incidence of systemic inflammatory response syndrome (SIRS), sepsis, and multiple organ dysfunction syndrome (MODS) were analyzed. Total in-patient time, mortality, and the requirement for blood products were evaluated. Logistic regression analyses were performed. Injury severity was comparable in both groups but there were more severe abdominal injuries in alcohol-intoxicated patients. The clinical course was comparable in both groups. Alcohol consumption was not an independent risk factor to sustain SIRS (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.59–1.70), sepsis (OR, 0.84; 95% CI, 0.54–1.31), or for mortality (OR, 1.08; 95% CI, 0.53–2.13). There was a trend toward an increased incidence of MODS in alcohol-intoxicated patients (OR, 2.74; 95% CI, 0.90–8.35). Blood alcohol level at the time of admission is not a valuable marker for worse or improved outcome in multiple trauma patients. There were no ethanol-related differences concerning overall injury severity; however, more severe abdominal injuries were found in alcohol-intoxicated patients. There was no increased risk for posttraumatic complications in primarily alcohol–intoxicated multiple trauma patients.

Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II score compared with trauma scores in the outcome of multiple-trauma patients

Background Prospective data regarding the prognostic value of the Sequential Organ Failure Assessment (SOFA) score in comparison with the Simplified Acute Physiology Score (SAPS II) and trauma scores on the outcome of multiple-trauma patients are lacking. Methods Single-center evaluation (n = 237, Injury Severity Score [ISS] >16; mean ISS = 29). Uni- and multivariate analysis of SAPS II, SOFA, revised trauma, polytrauma, and trauma and ISS scores (TRISS) was performed. Results The 30-day mortality was 22.8% (n = 54). SOFA day 1 was significantly higher in nonsurvivors compared with survivors ( P < .001) and correlated well with the length of intensive care unit stay ( r = .50, P < .001). Logistic regression revealed SAPS II to have the best predictive value of 30-day mortality (area under the receiver operating characteristic = .86 ± .03). The SOFA score significantly added prognostic information with regard to mortality to both SAPS II and TRISS. Conclusions The combination of critically ill and trauma scores may increase the accuracy of mortality prediction in multiple-trauma patients.

The value of the Glasgow Coma Scale and Injury Severity Score: predicting outcome in multiple trauma patients with head injury.

This retrospective study of multiple trauma patients requiring SICU admission was undertaken to determine to what extent, if any, head injury affected patient outcome. One hundred seventy such patients with head injuries had further analysis. Glasgow Coma Scale (GCS) values at approximately 5 hours postinjury were evaluated, and the Glasgow Outcome Scale was determined 1 month postinjury. A good recovery was seen in 99% of the 87 patients with GCS 15-13. This fell to 71% of the 24 patients with GCS 12-9. Among 59 patients having a GCS below 9, 41% died and an additional 17% had a poor recovery, leaving only 35% with an eventual good outcome. By using both Injury Severity Score and GCS at 6 hours postinjury, physicians will be more accurate in assessing outcome of multiple trauma patients with head injuries.