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

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