UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, España.
Emergencias. 2021;33(2):121-127.
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.
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.
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.
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.
比较格拉斯哥昏迷量表（GCS）评分为 3 分的患者根据瞳孔反应进行分层，并探讨双侧固定性瞳孔散大患者住院死亡的相关因素。
前瞻性、观察性、多中心研究。我们纳入了 2015 年 3 月至 2019 年 12 月期间因创伤收入重症监护病房且 GCS 评分为 3 分的所有患者。使用多元回归分析探讨双侧瞳孔散大患者住院死亡的相关因素。
在纳入的 933 例患者中，454 例（48.7%）患者的瞳孔有反应，201 例（21.5%）患者有单侧固定性瞳孔散大，278 例（29.8%）患者双侧瞳孔散大。3 组患者的院内死亡率均较高：瞳孔正常有反应的患者为 32.5%，单侧瞳孔无反应的患者为 54.6%，双侧瞳孔散大的患者为 91.0%。与院内死亡显著相关的因素是年龄、头部简明损伤量表评分 3 分或以上、休克或难治性休克。GCS 评分为 3 分且双侧瞳孔散大的患者中，I 型或 II 型弥漫性病变和已清除的肿块病变是保护因素。在双侧瞳孔散大且 GCS 评分为 3 分的 26 例患者中，有 12 例（46.1%）出院时 GCS 评分为 14 或 15。
本研究中，GCS 评分为 3 分且双侧瞳孔散大的创伤患者院内死亡率为 91%。与院内死亡显著相关的因素是年龄、头部简明损伤量表评分 3 分或以上、休克或难治性休克。GCS 评分为 3 分且双侧瞳孔散大的患者中，I 型或 II 型弥漫性病变和已清除的肿块病变是保护因素。
