Can Serum Glucose Level in Early Admission Predict Outcome in Patients with Severe Head Trauma?

Salehpour, F and Bazzazi, A.M and Aghazadeh Attari, J and Abbasivash, R and Forouhideh, Y and Mirzaei, F and Naseri Alavi, S.A (2016) Can Serum Glucose Level in Early Admission Predict Outcome in Patients with Severe Head Trauma? World Neurosurgery, 87. pp. 132-135.

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Abstract

Traumatic brain injury is a major general health concern. This study aims to evaluate a possible relationship between the serum level of glucose during admission and the outcome of patients with severe traumatic brain injury. - METHODS: In this prospective study, 80 patients with severe traumatic brain injury were recruited from the emergency department of Urmia Imam Khomeini Hospital. Serum level of glucose was measured at the time of admission and its correlation was investigated with the Glasgow Coma Scale score (on admission, 24 hours, 48 hours, and 1 week later, and at discharge) and Glasgow Outcome Score. In addition, the value of admission serum glucose was compared between deceased and discharged patients. - RESULTS: Eighty patients with severe head trauma, 71men (88%) and 9 women (11.2%) with a mean age of 31.71 � 15.66 years, were enrolled into the study. The in-hospital mortality rate was 25% (n [ 20). There was no significant correlation between serum glucose level and GlasgowComa Scale score (at different intervals) or Glasgow Outcome Score. The mean serum level of glucose was comparable between deceased and discharged patients (186.10� 51.36 vs. 187.98� 76.03 mg/ dL, respectively; P[0.91). - CONCLUSIONS: Admission serum glucose is not a significant indicator of outcome in patients with severe head trauma. INTRODUCTION Despite tremendous progress in modern medicine, traumatic brain injury still constitutes a huge burden worldwide. Although most cases (75%e80%) involve mild lesions, almost all patients with severe head trauma and roughly two thirds of patients with moderate head trauma have lifelong disability.1 Primary injury is caused by direct mechanical damage and secondary (delayed nonmechanical) damage is induced by changes in cerebral blood flow (such as hypoperfusion and hyperperfusion), inadequate cerebral oxygenation, and impairment of cerebrovascular autoregulation, cerebral metabolic dysfunction, excitotoxic cell damage, and inflammation. Primary damage cannot be therapeutically influenced, and treatment should focus on secondary damage.2,3 According to some reports, patients with head trauma and hyperglycemia may have a lower Glasgow Coma Scale (GCS) score4-6 and have an unfavorable neurologic outcome. Acute hyperglycemia is probably a result of stress-induced catecholamine release.7,8 Some investigators9 do not believe that there is a relationship between hyperglycemia and poor prognosis in head trauma. They believe that this hyperglycemia is transient and is merely a physiologic body response to injury. The present prospective study investigates a possible association between serum glucose levels of patients with severe head trauma at the time of admission with in-hospital prognosis. METHODS After approval by the ethics committee of Urmia University of Medical Sciences, this prospective cross-sectional study was performed in an emergency department and intensive care unit over a 24-month period (January 2011eDecember 2012). Written informed consent was obtained from the patients’ accompanying

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