Statistical Validation of the Glasgow Coma Score

Moore, Lynne; Lavoie, André; Camden, Stéphanie; Sage, Natalie Le; Sampalis, John S.; Bergeron, Éric; Abdous, Belkacem

doi:10.1097/01.ta.0000195593.60245.80

Cited by 86 publications

(78 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ignoring them could influence the results and decrease the statistical power. Multiple imputation is an increasingly chosen solution to minimize bias and increase precision [31][32][33]. The imputation model applied in this study was based on literature [34].…”

Section: Discussionmentioning

confidence: 99%

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Munter

Polinder

Nieboer

et al. 2018

Injury

View full text Add to dashboard Cite

A B S T R A C TIntroduction: Previous research showed that there is no agreement on a practically applicable model to use in the evaluation of trauma care. A modification of the Trauma and Injury Severity Score (modified TRISS) is used to evaluate trauma care in the Netherlands. The aim of this study was to evaluate the prognostic ability of the modified TRISS and to determine where this model needs improvement for better survival predictions. Methods: Patients were included if they were registered in the Brabant Trauma Registry from 2010 through 2015. Missing values were imputed according to multiple imputation. Subsets were created based on age, length of stay, type of injury and injury severity. Probability of survival was calculated with the modified TRISS. Discrimination was assessed with the Area Under the Receiver Operating Curve (AUROC). Calibration was studied graphically. Results: The AUROC was 0.84 (95% CI: 0.83, 0.85) for the total cohort (N = 69 747) but only 0.53 (95% CI: 0.51, 0.56) for elderly patients with hip fracture. Overall, calibration of the modified TRISS was adequate for the total cohort, with an overestimation for elderly patients and an underestimation for patients without brain injury. Conclusions: Outcome comparison conducted with TRISS-based predictions should be interpreted with care. If possible, future research should develop a simple prediction model that has accurate survival prediction in the aging overall trauma population (preferable with patients with hip fracture), with readily available predictors.

show abstract

Section: Discussionmentioning

confidence: 99%

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Munter

Polinder

Nieboer

et al. 2018

Injury

View full text Add to dashboard Cite

show abstract

“…Complete-case analysis results in loss of precision of reported estimates because of the reduction in the sample size and will likely bias the estimates, unpredictably, unless censored values are MCAR and thus the complete cases are a random sample of all cases (see Figures 2-5 in the article by Newgard and Haukoos in this issue of Academic Emergency Medicine 7 ). 8,13,14,[18][19][20][21][22][23] This method is only justifiable when the loss of precision and potential for bias are believed to be minimal, usually when the proportion of complete cases is high, although a small proportion (i.e., <5%) of censored data may still bias estimates substantially. 8 Unfortunately, the degree of bias and reduction in precision can be difficult to predict using complete-case analysis, because they depend not only on the proportion of censored data but also on the underlying pattern of censoring, the extent to which complete cases differ from incomplete cases, and the parameters of interest.…”

Section: Complete-case Analysismentioning

confidence: 99%

Advanced Statistics: Missing Data in Clinical Research—Part 1: An Introduction and Conceptual Framework

Haukoos

Newgard

2007

Academic Emergency Medicine

163

View full text Add to dashboard Cite

Missing data are commonly encountered in clinical research. Unfortunately, they are often neglected or not properly handled during analytic procedures, and this may substantially bias the results of the study, reduce study power, and lead to invalid conclusions. In this two-part series, the authors will introduce key concepts regarding missing data in clinical research, provide a conceptual framework for how to approach missing data in this setting, describe typical mechanisms and patterns of censoring of data and their relationships to specific methods of handling incomplete data, and describe in detail several simple and more complex methods of handling such data. In part 1, the authors will describe relatively simple approaches to handling missing data, including complete-case analysis, available-case analysis, and several forms of single imputation, including mean imputation, regression imputation, hot and cold deck imputation, last observation carried forward, and worst case analysis. In part 2, the authors will describe in detail multiple imputation, a more sophisticated and valid method for handling missing data.ACADEMIC EMERGENCY MEDICINE 2007; 14:662-668 ª

show abstract

“…Sustancias comúnmente asociadas con depresión del estado de conciencia y coma a . riesgo de mortalidad intrahospitalaria [32][33][34] . En un estudio observacional realizado en un servicio de urgencias del Reino Unido, pacientes sin trauma que ingresaron con Glasgow menor a ocho, en quienes se decidió un manejo conservador, sin requerimientos de intubación, no se presentaron complicaciones como bronco aspiración y se disminuyeron los días de estancia hospitalaria 33 .…”

Section: Manejo En El Servicio De Urgenciasunclassified

Alteración del estado de conciencia en el paciente intoxicado

Mejía

Ramos

Calzada

2017

MedUPB

View full text Add to dashboard Cite

Alteración del estado de conciencia en el paciente intoxicadoAlterations in the state of consciousness in intoxicated patients / Alteração do estado de consciência no paciente intoxicado Marie Claire Berrouet Mejía 1 Natalia Eugenia Pino Ramos 2 Marcela Castro Botero 3 Ubier Eduardo Gómez Calzada 4 RESUMEN La disminución del estado de conciencia, específicamente el coma, es un motivo de consulta frecuente en el servicio de urgencias y constituye un reto para el personal de salud por el número de condiciones amenazantes de la vida que se acompañan de este signo clínico. La toxicidad en el sistema nervioso central es una de las manifestaciones más comunes en el paciente intoxicado por cuanto se han encontrado signos y síntomas hasta en un 30%. Este porcentaje es considerable en personas en edad laboral pues la morbilidad derivada de un retraso en la atención y las lesiones secundarias, implican repercusiones sociales. Según su acción en el sistema nervioso central los xenobióticos se dividen en dos grupos: estimulantes que causan agitación, delirium o convulsiones y depresores que provocan grados variables de alteración en el estado de conciencia, desde la somnolencia hasta el coma. El propósito de este artículo es revisar las sustancias depresoras, con enfoque en el coma de origen tóxico. Además de la fisiopatología y los principales tóxicos implicados, se plantea, con base en la evidencia, la mejor aproximación a esta clase de pacientes con el objeto de favorecer el uso razonable de los recursos disponibles y evitar complicaciones y disminuir costos al sistema de salud. Palabras clave: conciencia; sistema nervioso central; coma; toxicidad; envenenamiento agudo; estado mental alterado. ABSTRACTDepression of consciousness -coma, specifically -is a frequent complaint in the emergency room consultation and is a challenge for health personnel, considering the number of life-threatening conditions that may be associated with this clinical sign. Toxicity in the central nervous system is one of the most common manifestations in the poisoned patient, where signs and symptoms have been found in up to 30%. This percentage is significant in working-age individuals as morbidity resulting from a delay in care and secondary lesions involves a social impact. According to their effect on the central nervous system, xenobiotics can be divided into two groups: stimulants that cause states of agitation, delirium or convulsions, and depressants that cause varying degrees of alteration in the state of consciousness, anywhere from drowsiness to coma. The purpose of this article was to review depressants, focusing on coma induced by intoxication. In addition to reviewing the pathophysiology and the main toxic substances involved, we consider the best approach to this class of patients based on the evidence, in order to favor the reasonable use of resources available, while avoiding complications and reducing health system costs.

show abstract

Statistical Validation of the Glasgow Coma Score

Cited by 86 publications

References 19 publications

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Advanced Statistics: Missing Data in Clinical Research—Part 1: An Introduction and Conceptual Framework

Alteración del estado de conciencia en el paciente intoxicado

Contact Info

Product

Resources

About