Correlation between Glasgow coma score components and survival in patients with traumatic brain injury
Introduction
The Glasgow coma scale (GCS) has been universally established as a common diagnostic tool to evaluate the consciousness, clinical status, as well as the prognosis of traumatic brain injury (TBI) patients.1, 9, 16 The GCS score is based on the simple addition of the 3 components evaluated, eye (E), motor (M) and verbal (V). Multiple studies have reported the predictive value of the GCS, alone or in combination with other clinical factors, in determining the outcomes of patients who have sustained brain injury.7, 8, 10, 13 Though the score is useful in the evaluation of TBI patients, an accurate and complete GCS score is difficult to obtain in many situations, e.g., if the patient is intubated or they have excessive swelling of the eyelids, thus decreasing the ability of physicians to provide appropriate care. A simplified assessment system using fewer parameters for predicting survival of TBI patients may make training of medical professionals easier, lead to less variability in reporting, and allow more accurate assessment across a broader range of clinical scenarios. Thus, many authors have recognised the limitations of the GCS and have sought to improve its functionality and simplify its use.3, 4, 11 A report by Healey et al.5 suggested that the motor component of the GCS contains all of the information of the complete score, and the authors recommended using the motor score alone in outcome prediction models.
TBI accounts for 12.5% of all the traumatic injuries in Taiwan, and the mortality rate of the patients with moderate to severe TBI is as high as 35%. Data of patients who died from traumas indicate that 55% of deaths were caused by TBI. The Head Injury Registry is an electronic database of TBI cases in Taiwan, archived by the Injury Prevention Center at Taipei Medical University, and supported by the Department of Health. This registry provides a valuable resource for research into the causes and outcomes of TBI.
In this retrospective study we sought to determine the association of individual GCS component scores, and combinations of the scores, as predictors of mortality in TBI patients by reviewing the records of TBI cases archived in the Head Injury Registry.
Section snippets
TBI subject inclusion and exclusion criteria
A TBI patient was defined as a patient who, after having received direct or indirect trauma to the head, exhibited brain concussion, contusion, skull fracture, or any of their clinical manifestations such as loss of consciousness, amnesia, neurological deficits, and seizures. Clinical evidence of skull fractures and intracranial hemorrhage, e.g., positive findings on radiographs or computed tomography (CT) were used to define the extent of TBI. In general, a patient with one or more of these
Results
Patient characteristics and E, M, V, and GCS scores are presented in Table 1. The mean ± standard deviation (SD) of age and E, M, V and GCS score were 41.6 ± 22.8, 3.6 ± 0.8, 5.6 ± 1.0, 4.4 ± 1.2, and 14.0 ± 2.9, respectively. Most of the subjects were males (63%) and had maximum E, M, V and GCS score (above 70%), and most injuries were sustained due to a traffic accident (54%) or fall (30%). Approximately 31% of subjects had an intracranial hemorrhage, and 11% had a skull bone fracture. The mortality rate
Discussion
Simplifying predictive models of survival in TBI has significant clinical utility. Accurate and complete GCS scores are difficult to obtain in many situations and a simplified assessment system using fewer parameters may make training of medical professionals easier, lead to less variability in reporting and more accurate patient assessments. In this large, retrospective study of TBI patients, we have found that combinations of the individual components of the GCS score, and even a single
Conclusion
The results of this study indicate that the 3 fundamental elements comprising the Glasgow coma scale, E, M and V, individually, and in certain combinations are predictive of the survival of TBI patients. This observation is clinically useful when evaluating TBI patients in whom a complete GCS score cannot be obtained.
Conflict of interest statement
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Acknowledgements
The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: National Health Research Institute, Taiwan (Grant No. NHRI-EX99-9707PI); Department of Health, Executive Yuan, Taiwan (Grant No. DOH99-TD-B-111-003).
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