What percentage of patients with mild traumatic brain injury (TBI), as indicated by a Glasgow Coma Scale (GCS) score, require surgical intervention?

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Porcentaje de Pacientes con Traumatismo Encefálico Leve que Requieren Intervención Quirúrgica

Menos del 1% de los pacientes con traumatismo encefálico leve (Glasgow 14-15) requieren intervención neuroquirúrgica, aunque hasta un 15% pueden presentar lesiones intracraneales en la tomografía computarizada. 1

Datos Epidemiológicos Específicos por Escala de Glasgow

Pacientes con Glasgow 15

  • 0.4-1% requieren intervención neuroquirúrgica 1, 2
  • 6.5-8.2% presentan lesiones intracraneales en TC 1
  • En pacientes sin pérdida de conciencia ni amnesia: 0.5% requieren neurocirugía 1

Pacientes con Glasgow 14

  • Aproximadamente 3% requieren intervención neuroquirúrgica 1
  • Hasta 30% o más presentan anormalidades en TC 2

Pacientes con Glasgow 13-15 (Conjunto)

  • 1% del total requieren intervención neuroquirúrgica 1, 2
  • 13.1% presentan progresión en TC de control 3
  • 3.5% eventualmente requieren intervención neuroquirúrgica según datos japoneses 4

Factores Predictores de Intervención Quirúrgica

Los siguientes factores aumentan significativamente el riesgo de requerir neurocirugía: 1, 3

  • Fractura de cráneo desplazada: aumenta 10 veces el riesgo 3
  • Déficit de base >4: aumenta 21 veces el riesgo 3
  • Hematoma subdural ≥10 mm: aumenta 8 veces la progresión en TC 3
  • Hematoma epidural ≥10 mm: aumenta 5 veces la progresión en TC 3
  • Signos de fractura de base de cráneo 1
  • Coagulopatía 1

Consideraciones Clínicas Importantes

Progresión de Lesiones

  • 13.1% de pacientes con Glasgow 13-15 y lesión intracraneal inicial muestran progresión en TC de control 3
  • Un Glasgow "leve" no excluye la necesidad de intervención quirúrgica en presencia de lesión intracraneal 3

Mortalidad

  • Tasa de mortalidad: 0.1% en traumatismo encefálico leve general 5
  • 3% de mortalidad relacionada con TEC leve en pacientes con lesión intracraneal complicada 4

Advertencias Críticas

Nunca asuma que un Glasgow de 13-15 garantiza evolución benigna si existe lesión intracraneal documentada. 3 La clasificación de "leve" basada únicamente en Glasgow puede ser engañosa cuando hay hemorragia intracraneal o fractura de cráneo. 3

Los pacientes que requieren sedantes, agentes hiperosmolares o hiperventilación tienen peor pronóstico neurológico (OR 2.36-9.36), aunque esto refleja mayor gravedad de la lesión subyacente. 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Mild traumatic brain injury.

European journal of neurology, 2012

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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