Non-normality of distribution of Glasgow Coma Scores and Revised Trauma Scores

Background:Trauma is one of the leading causes of death and disability in Indian population.Aim:To correlate various variables like epidemiology, clinical status, severity of TBI & associated co-morbid conditions and its outcome.Settings and Design:This study involved retrospective collection, prospective management and follow up of 796 cases of TBI admitted to the neurosurgery department of a tertiary care hospital in New Delhi during one year study duration.Materials and Methods:All the relevant variables recorded and analyzed with Glasgow Outcome Scale (GOS) in 6 months into 3 groups i.e. group 1 (GOS-1/Dead), group 2 (GOS-2&3/Bad) and group 3- (GOS-3&4/good).Statistical Analysis:Compiled data collected, analyzed and difference between two proportions was analyzed using Chi Square test.Results:This study included 791 cases with 569 (72%) males and 222 (28%) females with average age of 24 years. Fall from height was the main cause of TBI (56%) followed by road traffic injury (RTI) (36%). Majority (61%) patients reached the hospital within 6 hours of injury out of which 27% patients were unconscious. As per Glasgow coma scale mild, moderate & severe grade of TBI was seen in 62%, 22% &16% cases respectively. Radiological examination of other body parts revealed injuries in 11% cases. Only 11% cases required surgical management, rest was managed conservatively. Good outcome noted in 80% cases and 20% cases expired. Average duration of hospital stay was 5 days. According to multivariate analysis, the factors which correlated with poor prognosis are presence of radiological injuries to other body parts, GCS, abnormal cranial nerve examination, abnormal plantar and abnormal pupillary reflex. (P < 0.05)Conclusion:TBI predominantly affects young male population and most of these are preventable. Early transportation to the hospital and first aid results in good outcome. Mortality increases with the severity of TBI and associated injuries therefore multimodality approach in polytrauma is essential.

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“…Since GCS do not follow a normal distribution, studies employing mean GCS values and standard statistical analysis are misleading. [ 13 ]…”

Section: Introductionmentioning

confidence: 99%

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)

Shekhar

Gupta

Premsagar

et al. 2015

J Emerg Trauma Shock

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“…On an ordinal scale, the difference between unit values is not consistent and only compares better with worse. Because the GCS is ordinal, it is difficult to compare a group with a score of 10 with a group with a score of 12 25 …”

Section: Trauma Systems Classificationsmentioning

confidence: 99%

“…The RTS effectively incorporates the severity of head injury as a predictor of mortality and is easy to use in the field, even before full knowledge of patients’ injured organs 12 , 28 . The RTS’ developers claim that an RTS of 12 suggests the need for triage to a major trauma centre; however, others have criticized this cut‐off as overly conservative 6 , 13 , 25 , 27 …”

Section: Trauma Systems Classificationsmentioning

confidence: 99%

Trauma scoring systems explained

1999

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Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug‐Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter‐institutional comparisons and facilitate trauma research.

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“…Because the GCS is ordinal, it is difficult to compare a group with a score of 10 with a group with a score of 12. 25 The GCS is simple to apply. It is used by most emergency medical services systems in the field, by a great number of emergency department (ED) triage nurses to determine urgency of care, by emergency physicians to document serial neurological examinations and has been incorporated into the American College of Surgeon's Advanced Trauma Life Support (ATLS) course.…”

Section: Glasgow Coma Scalementioning

confidence: 99%

“…12,28 The RTS' developers claim that an RTS of 12 suggests the need for triage to a major trauma centre; however, others have criticized this cut-off as overly conservative. 6,13,25,27 The RTS is more cumbersome to calculate than the GCS (which it incorporates). To begin the calculation, the GCS is converted from a simple 3-15 summation to a 4-0 score.…”

Section: Glasgow Coma Scalementioning

confidence: 99%

Trauma Scoring Systems Explained

Fani-Salek¹,

Totten²,

Terezakis

1999

Prehosp. Disaster med.

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Abstracts: 11th World Congress, Osaka, Japan S79 with 42 femoral and 11 tibial fractures were treated with either reamed intramedullary nailing (Group R, n = 28) or with unreamed nailing (Group NR, n = 20) within three days of their injuries. The mean value for age was 27.4 years (range, 16 to 63 years). In Group R, 28 femoral and four tibial fractures, reaming was performed up to 12.5 mm, and a 9-11 mm nail was inserted. In Group NR, 14 femur and 7 tibial fractures, a 9-10 mm nail was inserted without reaming. BAL was performed within 24 hours postoperatively with the standard procedure, in which sterile normal solution is instilled in 20 mL aliquots for a total of 100 ml, and immediately aspirated manually with a syringe. The cells contained in the lavage fluid were counted on uncentrifuged specimens by using a hemocytometer. The fluid then was centrifuged (1,500 rpm, 5 minutes), and differential cell counts were performed on a preparation that was stained with Wright-Giemsa stain. The percentage of lavage cells containing red or brown-red fat droplets (lipidladen cells) was calculated after examination of at least 200 cells on the slides stained with Sudan III, and the findings for two groups were compared. Results: The average age, ISS, and fracture index (Fl) were 28.1 ±12.4 years, 15.2 ±9.3, and 5.4 ±2.4 in Group R; and 26.3 ±11.7 years, 14.5 ±6.4, and 4.7±3.2 in Group NR, respectively. There were no significant differences between two groups. The mean percentage of lipid-laden cells in BAL fluid was 33.6 ±25.8% (range, 2 -89%) for Group R and 36.6 ±21.3 % (range, 2-70%) in Group NR. This difference also was not significant statistically. In this study, no typical features of fat embolism syndrome were identified in any of the patients.

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Non-normality of distribution of Glasgow Coma Scores and Revised Trauma Scores

Cited by 20 publications

References 16 publications

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)

Trauma scoring systems explained

Trauma Scoring Systems Explained

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