The National Traumatic Coma Data Bank

Part 1: Design, purpose, goals, and results

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✓ This paper describes the pilot phase of the National Traumatic Coma Data Bank, a cooperative effort of six clinical head-injury centers in the United States. Data were collected on 581 hospitalized patients with severe non-penetrating traumatic head injury. Severe head injury was defined on the basis of a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation or deterioration to a GCS score of 8 or less within 48 hours after head injury.

A common data collection protocol, definitions, and data collection instruments were developed and put into use by all centers commencing in June, 1979. Extensive information was collected on pre-hospital, emergency room, intensive care, and recovery phases of patient care. Data were obtained on all patients from the time of injury until the end of the pilot study.

The pilot phase of the Data Bank provides data germane to questions of interest to neurosurgeons and to the lay public. Questions are as diverse as: what is the prognosis of severe brain injury; what is the impact of emergency care; and what is the role of rehabilitation in the recovery of the severely head-injured patient?

Article Information

This report was prepared by Dr. Marshall and Ms. Bowers from the University of California, San Diego, California; Dr. Becker and Mr. Warren from the Medical College of Virginia, Richmond, Virginia; Ms. Cayard and Dr. Eisenberg from the University of Texas, Galveston, Texas; Dr. Gross and Ms. Kunitz from the Office of Biometry and Field Studies of The National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, Maryland; Dr. Grossman from Baylor College of Medicine, Houston, Texas; Dr. Jane and Ms. Rimel from the University of Virginia, Charlottesville, Virginia; and Dr. Tabaddor from Albert Einstein College of Medicine, New York, New York.

Address reprint requests to: Lawrence F. Marshall, M.D., Division of Neurological Surgery, University Hospital, University of California Medical Center-San Diego, 225 Dickinson Street, San Diego, California 92103.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Characteristics of accident

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    ICU form to record ICP data, vital signs, and pupillary responses

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    ICU form to list treatment

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    Graphs illustrating codes for intracranial pressure analysis.

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    ICU form emphasizing neurological status, and laboratory findings

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    Summary of computerized tomography findings

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    Details of surgical treatment

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    Distribution of mechanisms of injury in four age groups. Motor-vehicle accidents were the predominant mode of injury in all but the oldest age group, where falls accounted for almost half the injuries.

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    Left: Total numbers of males and females reported for each 5-year age group. There were more males in each interval up to age 65, but the most extreme differences between the sexes were seen between the ages of 15 and 39 years. Right: Proportions of males and females reported for each 5-year age group. The age distributions of males and females were very similar, despite the disparity in actual frequency.

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    Distribution of initial Glasgow Coma Scale scores in each of two age groups. Numbers above each bar indicate the actual number of cases. The patients indicated by an asterisk were not in coma at their initial evaluation but deteriorated to a score of 8 or less within 48 hours of injury.

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    Proportion of patients who died within 7 days of injury categorized by their initial Glasgow Coma Scale score. Numbers in parentheses are the number of deaths compared with the total number of patients in each category.

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    Distribution of component values from the initial Glasgow Coma Scale (GCS) evaluation. In the combined GCS score, untestable values were treated as no response. The component value most frequently unavailable was verbal response (due to intubation).

References

1.

Gross CRDambrosia JM: Quality assurance for clinical data banks in Heffernan HG (ed): Proceedings: The Fifth Annual Symposium on Computer Applications in Medical CareNovember, 1981. New York: Computer Society Press (IEEE)1981 pp 317321Gross CR Dambrosia JM: Quality assurance for clinical data banks in Heffernan HG (ed): Proceedings: The Fifth Annual Symposium on Computer Applications in Medical Care November 1981. New York: Computer Society Press (IEEE) 1981 pp 317–321

2.

Jennett BTeasdale GGalbraith Set al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry40:2912981977Jennett B Teasdale G Galbraith S et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298 1977

3.

Teasdale GJennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet2:81831974Teasdale G Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–83 1974

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