The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better?

Cheng, Katarina; Bassil, Ribal; Carandang, Raphael A.; Hall, Wiley R.; Muehlschlegel, Susanne

doi:10.1089/neu.2016.4657

Cited by 18 publications

(15 citation statements)

References 30 publications

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“…There are few studies, noted to different calibration for these predictive models. [152930] These discrepancies and different sensitivity and specificity values in some studies[528] can be elucidate by the fact that a predictive model based on validation and testing set from one population when transferred to another population without modification will often lose its accuracy. [15] By recalibrating these models frequently, we may be overcome these problems with taking into account the changes in settings, quality of care and improved survival.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…One of the greatest obstacles in the assessment of verbal response is endotracheal intubation. [22][23][24][25][26] New methods include assigning the lowest possible score to untestable components and pseudoscoring missing values on the basis of testable features. 24 Our study found a substantial (not near-perfect) level of agreement among observers for patients' verbal responses, possibly because of the challenges associated with assigning scores for intubated patients.…”

Section: Verbal Responsementioning

confidence: 99%

“…The resulting unreliable GCS scores may affect prognostication, treatment, and decision-making by health care providers. 25 In our study, we advised observers to evaluate nonsedated, intubated patients' verbal responses by having patients write or point to letters if they were able to obey commands. Health care providers need precise information to assign accurate values to the untestable verbal components for patients receiving mechanical ventilation.…”

Section: Verbal Responsementioning

confidence: 99%

Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients

Kebapçı

Dіkeç

Topçu

2020

Critical Care Nurse

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Background Intensive care units frequently use the Glasgow Coma Scale to objectively assess patients’ levels of consciousness. Interobserver reliability of Glasgow Coma Scale scores is critical in determining the degree of impairment. Objective To evaluate interobserver reliability of intensive care unit patients’ Glasgow Coma Scale scores. Methods This prospective observational study evaluated Glasgow Coma Scale scoring agreement among 21 intensive care unit nurses and 2 independent researchers who assessed 202 patients with neurosurgical or neurological diseases. Each assessment was completed independently and within 1 minute. Participants had no knowledge of the others’ assessments. Results Agreement between Glasgow Coma Scale component and sum scores recorded by the 2 researchers ranged from 89.5% to 95.9% (P = .001). Significant agreement among nurses and the 2 researchers was found for eye response (73.8%), motor response (75.0%), verbal response (68.1%), and sum scores (62.4%) (all P = .001). Significant agreement among nurses and the 2 researchers (55.2%) was also found for sum scores of patients with sum scores of 10 or less (P = .03). Conclusions Although the study showed near-perfect agreement between the 2 researchers’ Glasgow Coma Scale scores, agreement among nurses and the 2 researchers was moderate (not near perfect) for subcomponent and sum scores. Accurate Glasgow Coma Scale evaluation requires that intensive care unit nurses have adequate knowledge and skills. Educational strategies such as simulations or orientation practice with a preceptor nurse can help develop such skills.

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“…In the few studies that undertook a sensitivity analysis, imputation was compared with exclusion of missing values. [26][27][28][29][30] A sensitivity analysis can specifically test any bias that the researcher is concerned about. For example, if one suspects that patients with good recovery are less inclined to return for followup, one could specifically impute more favorable outcomes for the lost patients to assess whether the conclusions still hold.…”

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confidence: 99%

Handling of Missing Outcome Data in Traumatic Brain Injury Research: A Systematic Review

Richter

Stevenson

Newman

et al. 2019

Journal of Neurotrauma

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Traumatic brain injury (TBI) research commonly measures long-term functional outcome, but studies often suffer from missing data as patients are lost to follow-up. This review assesses the extent and handling of missing outcome data in the TBI literature and provides a practical guide for future research. Relevant electronic databases were searched from January 1, 2012 to October 27, 2017 for TBI studies that used the Glasgow Outcome Scale or Glasgow Outcome Scale-Extended (GOS/GOSE) as an outcome measure. Studies were screened and data extracted in line with Cochrane guidance.A total of 195 studies, 21 interventional, 174 observational, with 104,688 patients were included. Using the reported follow-up rates in a mixed model, on average 91% of patients were predicted to return to follow-up at 6 months post-injury, 84% at 1 year, and 69% at 2 years. However, 36% of studies provided insufficient information to determine the number of subjects at each time-point. Of 139 studies that did report missing outcome data, only 50% attempted to identify why data were missing, with just 4 reporting their assumption on the “missingness mechanism.” The handling of missing data was heterogeneous, with the most common method being its exclusion from analysis. These results confirm substantial variability in the standard of reporting and handling of missing outcome data in TBI research. We conclude that practical guidance is needed to facilitate meaningful and accurate study interpretation, and therefore propose a framework for the handling of missing outcome data in future TBI research.

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The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better?

Cited by 18 publications

References 30 publications

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

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

Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients

Handling of Missing Outcome Data in Traumatic Brain Injury Research: A Systematic Review

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