Search

The wide‐spread use of an initial 'Glasgow Coma Scale (GCS) 8 or less' to define and dichotomise 'severe' from 'mild' or 'moderate' traumatic brain injury (TBI) is an out‐dated research heuristic that has become an epidemiological convenience transfixing clinical care. Triaging based on GCS can delay the care of patients who have rapidly evolving injuries. Sole reliance on the initial GCS can therefore provide a false sense of security to caregivers and fail to provide timely care for patients presenting with GCS greater than 8. Nearly 50 years after the development of the GCS – and the resultant misplaced clinical and statistical definitions – TBI remains a heterogeneous entity, in which 'best practice' and 'prognoses' are poorly stratified by GCS alone. There is an urgent need for a paradigm shift towards more effective initial assessment of TBI. [ABSTRACT FROM AUTHOR]

Cervical spine fractures are common in older adults, although reports of the epidemiology and outcomes of this patient cohort are scant. The aim of this study was to review the epidemiology, management and outcomes (hospital-based and patient-reported) of older patients with cervical fractures admitted to a level 1 trauma centre.Patients aged ≥65 years who were admitted to The Alfred and included on the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) with a cervical spine fracture were included. Demographics and management (surgery, halo thoracic orthosis or conservative), as well as hospital and 6-month outcomes were analysed. Factors associated with cervical spine management and outcomes (discharge destination and being at home at 6 months post-injury) were assessed using logistic regression.Between 2016 and 2021, a total of 853 patients were included. Median age was 79 (IQR 72–86) years, with most (57.7%) being male. Low falls (59%) were common. Most patients were managed non-operatively [765 (89%)]. The median acute hospital length of stay was 6.8 (IQR 3.8–11.6) days and 90.6% of patients survived to hospital discharge. After adjusting for confounding factors, increasing age, female gender and having an intensive care unit stay were associated with discharge to another inpatient facility as well as not returning to live at home at 6 months. There was no association between the cervical spine management and 6-month quality of life outcomes.Overall mortality rate was low with most patients returning to independent living at home 6 months post-injury. Considering those factors associated with poorer outcomes may provide useful information to determine optimal pathways for this cohort. [ABSTRACT FROM AUTHOR]