{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T08:15:12Z","timestamp":1773303312126,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients\u2019 characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score\u2009&lt;\u200913, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 77 patients were included in this study. Fifty\u2010eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85, <jats:italic>p<\/jats:italic>\u2009=\u20090.017), early airway protection in ED (odds 25.02, <jats:italic>p<\/jats:italic>\u2009=\u20090.018) and 72\u2010h GCS score improvement by two points (odds 0.02, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72\u2010h GCS score regained consciousness. The association between days to <jats:italic>M<\/jats:italic>5 status and days to <jats:italic>M<\/jats:italic>6 status (consciousness) was highly significant. Fewer days to <jats:italic>M<\/jats:italic>5 status were highly associated with needing fewer days to regain consciousness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72\u2010h GCS score. Regaining consciousness within a short period could be expected in patients with <jats:italic>M<\/jats:italic>5 status.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06747-y","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T18:02:47Z","timestamp":1663783367000},"page":"2882-2889","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT"],"prefix":"10.1002","volume":"46","author":[{"given":"Cheng\u2010Yu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chi\u2010Cheng","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching\u2010Chang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po\u2010Hsun","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting\u2010An","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University No. 5, Fu\u2010Hsing Street Kwei Shan Township, Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Chi","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University No. 5, Fu\u2010Hsing Street Kwei Shan Township, Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien\u2010Hung","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University No. 5, Fu\u2010Hsing Street Kwei Shan Township, Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chi\u2010Hsun","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University No. 5, Fu\u2010Hsing Street Kwei Shan Township, Taoyuan City Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih\u2010Yuan","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Chang Gung Medical College &amp; University No. 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