Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention

Ashkenazi, Itamar; Schecter, William P.; Peleg, Kobi; Givon, Adi; Olsha, Oded; Turégano-Fuentes, Fernando; Alfici, Ricardo; Bahouth, Hany; Becker, Alexander; Ely, Michael; Braslavsky, Alexander; Jeroukhimov, Igor; Qarawany, Milad; Kessel, Boris; Klein, Yoram; Lin, Guy; Merin, Ofer; Bala, Miklosh; Mnouskin, Y.; Rivkind, Avraham I.; Shaked, Gad; Soffer, Dror; Stein, Michael D.; Weiss, M.

doi:10.1001/jamasurg.2016.1742

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…The GCS score has been used to predict several outcomes of TBI patients. Previous findings suggest that it may not be used to predict the providing of neurosurgical interventions, 17 but it is independently associated with 1-year survival rates. 18 Age and the GCS total score obtained at the ED may predict the development of delirium in elderly patients with multiple organ traumas.…”

Section: Discussionmentioning

confidence: 99%

Delirium after a traumatic brain injury: predictors and symptom patterns

Maneewong¹,

Maneeton²,

Maneeton³

et al. 2017

NDT

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BackgroundDelirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI.MethodsTBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI. Apart from the sum score of GCS, which was obtained at the emergency department (ED), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for delirium were applied daily. The severity of delirium symptoms was assessed daily using the Delirium Rating Scale – Revised-98 (DRS-R-98).ResultsThe participants were 54 TBI patients with a mean GCS score of 12.7 (standard deviation [SD] =2.9). A total of 25 patients (46.3%) met the diagnosis of delirium and had a mean age of 36.7 years (SD =14.8). Compared with 29 non-delirious patients, 25 delirious patients had a significantly lower mean GCS score (P=0.04), especially a significantly lower verbal component score (P=0.03). Among 18 delirious patients, four symptoms of the DRS-R-98 cognitive domain (orientation, attention, long-term memory, and visuospatial ability) were moderate symptoms (score ≥2) at the first day of admission. After follow-up, three cognitive (orientation, attention, and visuospatial ability) and two noncognitive symptoms (lability of affect and motor agitation) rapidly resolved.ConclusionAlmost half of patients with mild to moderate head injuries may develop delirium in the first 4 days after TBI. Those having a low GCS score, especially the verbal component score, at the ED were likely to have delirium in this period. Most cognitive domains of delirium described in the DRS-R-98 were prominent within the first 4 days of TBI with delirium. Three cognitive and two noncognitive symptoms of delirium decreased significantly.

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Section: Discussionmentioning

confidence: 99%

Delirium after a traumatic brain injury: predictors and symptom patterns

Maneewong¹,

Maneeton²,

Maneeton³

et al. 2017

NDT

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“…[6789] However, there are still conflicting data concerning which of this two scoring systems has the best predictive value. [1011121314] External validation is an essential step before application of the predictive model in the group of patients who are different from that group originally used for model development. [15]…”

Section: Introductionmentioning

confidence: 99%

Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit

Ramazani

Hosseini

2019

Ann Card Anaesth

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Context: The Glasgow Coma Scale (GCS) is the most commonly used scale, and Full Outline of Unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS in the evaluation of the level of consciousness. Aim: The aim of the current study was to evaluate FOUR score and GCS ability in predicting the outcomes (Survivors, nonsurvivors) in Medical Intensive Care Unit (MICU). Setting and Design: This was an observational and prospective study of 300 consecutive patients admitted to the MICU during a 14 months’ period. Materials and Methods: FOUR score, GCS score, and demographic characteristics of all patients were recorded in the first admission 24 h. Statistical Analysis Used: A receiver operator characteristic (ROC) curve, Hosmer–Lemeshow test, and Logistic regression were used in the statistical analysis (95% confidence interval). Results: Data analysis showed a significant statistical difference in FOUR score and GCS score between survivors and nonsurvivors ( P < 0.0001, P < 0.0001; respectively). The discrimination power was good for both FOUR score and GCS (area under ROC curve: 87.3% (standard error [SE]: 2.1%), 82.6% [SE: 2.3%]; respectively). The acceptable calibration was seen just for FOUR score (χ 2 = 8.059, P = 0.428). Conclusions: Both FOUR score and GCS are valuable scales for predicting outcomes in patients are admitted to the MICU; however, the FOUR score showed better discrimination and calibration than GCS, so it is superior to GCS in predicting outcomes in this patients population.

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“…For example, Dehli and colleagues 18 found that the triage accuracy for major trauma (ISS >15) was almost the same, at an undertriage rate of 28%, also after a revision of the trauma team activation criteria, and that undertriaged patients had a higher frequency of neurosurgical injuries ( p < 0.05). Another example is the study by Ashkenazi and associates 21 that evaluated whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score could identify patients with severe TBI in need of neurosurgical intervention. The results were discouraging, because there was no statistically significant difference between the proportion of patients in need of neurosurgical procedures presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14 (30% vs. 27%; p = 0.83).…”

Section: Discussionmentioning

confidence: 99%

“…The results were discouraging, because there was no statistically significant difference between the proportion of patients in need of neurosurgical procedures presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14 (30% vs. 27%; p = 0.83). 21 …”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of a Microwave-Based Device for Detection of Traumatic Intracranial Hemorrhage

Ljungqvist

Candefjord

Persson

et al. 2017

Journal of Neurotrauma

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Traumatic brain injury (TBI) is the leading cause of death and disability among young persons. A key to improve outcome for patients with TBI is to reduce the time from injury to definitive care by achieving high triage accuracy. Microwave technology (MWT) allows for a portable device to be used in the pre-hospital setting for detection of intracranial hematomas at the scene of injury, thereby enhancing early triage and allowing for more adequate early care. MWT has previously been evaluated for medical applications including the ability to differentiate between hemorrhagic and ischemic stroke. The purpose of this study was to test whether MWT in conjunction with a diagnostic mathematical algorithm could be used as a medical screening tool to differentiate patients with traumatic intracranial hematomas, chronic subdural hematomas (cSDH), from a healthy control (HC) group. Twenty patients with cSDH and 20 HC were measured with a MWT device. The accuracy of the diagnostic algorithm was assessed using a leave-one-out analysis. At 100% sensitivity, the specificity was 75%—i.e., all hematomas were detected at the cost of 25% false positives (patients who would be overtriaged). Considering the need for methods to identify patients with intracranial hematomas in the pre-hospital setting, MWT shows promise as a tool to improve triage accuracy. Further studies are under way to evaluate MWT in patients with other intracranial hemorrhages.

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Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention

Cited by 11 publications

References 18 publications

Delirium after a traumatic brain injury: predictors and symptom patterns

Delirium after a traumatic brain injury: predictors and symptom patterns

Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit

Clinical Evaluation of a Microwave-Based Device for Detection of Traumatic Intracranial Hemorrhage

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