A Comparison of the Predictive Value of the Glasgow Coma Scale and the Kampala Trauma Score for Mortality and Length of Hospital Stay in Head Injury Patients at a Tertiary Hospital in Uganda: A Diagnostic Prospective Study

Abstract

Introduction. The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, “severe” patients, when scoring below the threshold and a good outcome “non severe” patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda. Methods. A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient’s demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison. Results. The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay. Conclusion. Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.

Factors Related To Outcome of Traumatic Brain Injury Patients at M Djamil Padang Hospital

“…Other mechanisms such as assault (36.8%), fall (5.8%), and shooting (0.5%). 12 This was also found in several other studies where traffic accidents were still the main injury mechanism from 58% to 98.6%. 4,16,17 Faal for the cause of injury was mostly at the age of 0-17 years and age >55 years, 18 while in this study the average age of the patients was 36.41 years (SD±14.275).…”

“…The median age was 30 years and the mean age was 32 years (SD ±11). 12 The mean of this study was also lower than a prospective multicenter study conducted in the Netherlands where the mean age was 47.3 ± 20.4 years with a mean severe brain injury of 46.1 ± 20.0 years. 16 In this study, the mean age of the subjects was lower due to differences in the inclusion criteria.…”

“…10 In another study, it was also found that out of 175 adult patients (>18 years) diagnosed with traumatic brain injury, the majority were male as 116 people (66.29%). 11 Male in their productive age becomes the most common brain injury patients, ie 78.4%, 12 with a male to female ratio of 4.9:1. 13 that the number of male traumatic brain injury patients was significantly higher than female in all age groups, namely 151 per 100,000 for male and 86 per 100,000 for female.…”

Evaluation of Functional, Cognitive and Emotional Outcomes and Pituitary Hormones According to Trauma Severity in Patients with Traumatic Brain Injury

“…9,10 Bununla birlikte GKS'nin, TBH sonrası mortalite ve hastanede kalış süresini tahmin etmede iyi performans gösterdiği, ancak uzun süreli sonuçları belirlemede yeterliliğinin yeniden gözden geçirilmesi gerektiği ve sonuca ilişkin prognostik değerinin hâlâ kanıtlardan yoksun olduğu rapor edilmiştir. 20,21 nuçlar arasında ilişkiyi değerlendiren bir çalışma, yaralanmadan 2 hafta sonra yapılan GKS'nin fonksiyonel sonuçlar ile ilişkili olduğunu not etmiştir. 22 Çalışmamızda, yaralanma üzerinden en az 6 ay geçen TBH'li hastalar, yaralanma sonrası ilk 24 saat içinde değerlendirilen GKS puanlarına göre orta ve ağır olarak gruplandırılmış, ağır TBH vakalarının orta düzey vakalarına göre günlük yaşam aktivitelerinde daha fazla fonksiyonel bağımlılık gösterdiği kaydedilmiştir.…”

Contribution of pupillary light reflex assessment to Glasgow Coma Scale for prognostication in patients with traumatic brain injury

“…The present study is the first to examine the difference between the four predictor variables in predicting mRS outcome at discharge in patients with TBI. Previous studies have compared GCS alone with GCS-P, Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, Full Outline of UnResponsiveness (FOUR) score, and Kampala Trauma score in predicting the mortality among patients in neurocritical care or general critical care [30][31][32]. In a study by Brennan et al [17] that compared GCS alone with GCS-P in predicting mortality, it was found that GCS-P was significantly better than GCS in predicting mortality as increasing the GCS-P was associated with a decrease in mortality which is similar to the results of our study that also indicate that a 1 unit change in GCS-P is associated with a -0.17 units change in mortality.…”