Relationship Between Brain CT Scan Findings, Consciousness Levels, and Outcomes in Brain Trauma Patients: A Cross-Sectional Study

Introduction: Trauma ranks as the fourth leading cause of mortality worldwide. Evaluating the consciousness levels of trauma patients involves a range of tools, among which the Glasgow Coma Scale (GCS) holds paramount importance. The GCS is a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. To this end, the study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS.
Methods: This cross-sectional descriptive-analytical study investigated ۲۰۰ brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients' consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists have determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS ۲۲, were employed to examine the relationship between consciousness levels and CT scan results.
Results: Three out of ۲۰۰ patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was ۲۷.۹۴ ± ۱۱.۲۵. Results showed that ۶۷.۵% of all patients survived, while ۳۲.۴% succumbed to injuries. The initial GCS score was ۱۴-۱۵ for ۸۳ patients (۴۲.۱%), ۹-۱۳ for ۶۹ patients (۳۵%), and ۳-۸ for ۴۵ patients (۲۲.۸%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in ۴۸ patients (۲۴.۳%). In the examination of the relationship between the mechanism of brain trauma and mortality, ۷۵% of patients involved in falls and ۶۵.۵% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=۰.۳۱۸). Furthermore, all patients with a GCS score of ۱۴-۱۵ (۱۰۰%), ۸۵.۶% with a GCS score of ۹-۱۳, and ۳۵.۵% with a GCS score of ۳-۸ survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=۰.۰۰۱). Statistical analysis indicated that ۶۶.۷% of patients with subdural hematomas, ۷۵% with epidural hematomas, ۸۱% with cerebral contusions, ۳۵.۳% with intracerebral hemorrhages (ICH), and ۹۲.۳% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=۰.۰۱). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of ۶۴.۷%.
Conclusion: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient's treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality.