The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients

Vivien, Benoît; Yeguiayan, Jean-Michel; Manach, Yannick Le; Bonithon‐Kopp, Claire; Mirek, Sébastien; Garrigue, Delphine; Freysz, M.; Riou, Bruno

doi:10.1016/j.ajem.2011.06.022

Cited by 13 publications

(5 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The higher accuracy of the MS in relation to the other components of the scale was also demonstrated in several other studies. [ 17 , 18 , 20 , 28 , 29 , 43 ] Thus, it is reasonable to use the best motor response associated with pupillary reactivity (i.e., MS-P), which, according to the AUC analysis in the present study, was superior for 14-day and in-hospital mortality prediction to both the GCS and GCS-P.…”

Section: Discussionmentioning

confidence: 77%

“…It is associated with outcome and has been used in several prediction models. [14,17,18,43] e motor component of the GCS appears to be the most powerful predictor of outcome, because it accounts for most of the predictive value of the score and is a component with high intra-and interobserver concordance. [17,29] Recently, Brennan et al suggested a new model by adding the pupil reactivity score to the GCS, creating the GCS-Pupils (GCS-P).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

External validation of the Glasgow coma scale-pupils in low- to middle-income country patients with traumatic brain injury: Could “motor score-pupil” have higher prognostic value?

Souza

Pipek²,

Fagundes

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

Background: The objective of this study is to validate the admission Glasgow coma scale (GCS) associated with pupil response (GCS-P) to predict traumatic brain injury (TBI) patient’s outcomes in a low- to middle-income country and to compare its performance with that of a simplified model combining the better motor response of the GCS and the pupilar response (MS-P). Methods: This is a prospective cohort of patients with TBI in a tertiary trauma reference center in Brazil. Predictive values of the GCS, GCS-P, and MS-P were evaluated and compared for 14 day and in-hospital mortality outcomes and length of hospital stay (LHS). Results: The study enrolled 447 patients. MS-P demonstrated better discriminative ability than GCS to predict mortality (AUC 0.736 × 0.658; P < 0.001) and higher AUC than GCS-P (0.736 × 0.704, respectively; P = 0.073). For hospital mortality, MS-P demonstrated better discrimination than GCS (AUC, 0.750 × 0.682; P < 0.001) and higher AUC than GCS-P (0.750 × 0.714; P = 0.027). Both scores were good predictors of LHS (r2 = 0.084 [GCS-P] × 0.079 [GCS] × 0.072 [MS-P]). Conclusion: The predictive value of the GCS, GCS-P, and MS-P scales was demonstrated, thus contributing to its external validation in low- to middle-income country.

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

External validation of the Glasgow coma scale-pupils in low- to middle-income country patients with traumatic brain injury: Could “motor score-pupil” have higher prognostic value?

Souza

Pipek²,

Fagundes

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…[12,24] Also, if the effect size is small, the problem of small sample size in our study (and others) resulting in a larger margin of error is compounded. [25] There is consensus that absence of pupil reaction to light predicts poor outcome and it has been included in several prognostic models. [7,8] Recently, it was reported that its predictive power increases when associated with other variables that also predict risk of death in TBI patients.…”

Section: Discussionmentioning

confidence: 99%

Predicting Mortality from Head Injury: Experience of Sancti Spíritus Province, Cuba

Rodríguez

2013

MEDICC Review

View full text Add to dashboard Cite

show abstract

“…26 However, Vivien et al 27 found a subtle increase in mortality rate in the low-risk stratum for MGAP, replacing the GCS by its motor component. Therefore, studying the two score models by using just best motor response only would be a topic for further research.…”

Section: Discussionmentioning

confidence: 99%

Validation and reclassification of MGAP and GAP in hospital settings using data from the Trauma Audit and Research Network

Hasler

Mealing

Rothen³

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

BACKGROUND:Recently, two simple clinical scores were published to predict survival in trauma patients. Both scores may successfully guide major trauma triage, but neither has been independently validated in a hospital setting. METHODS:This is a cohort study with 30-day mortality as the primary outcome to validate two new trauma scoresVMechanism, Glasgow Coma Scale (GCS), Age, and Pressure (MGAP) score and GCS, Age and Pressure (GAP) scoreVusing data from the UK Trauma Audit and Research Network. First, an assessment of discrimination, using the area under the receiver operating characteristic (ROC) curve, and calibration, comparing mortality rates with those originally published, were performed. Second, we calculated sensitivity, specificity, predictive values, and likelihood ratios for prognostic score performance. Third, we propose new cutoffs for the risk categories. RESULTS:A total of 79,807 adult (Q16 years) major trauma patients (2000Y2010) were included; 5,474 (6.9%) died. Mean (SD) age was 51.5 (22.4) years, median GCS score was 15 (interquartile range, 15Y15), and median Injury Severity Score (ISS) was 9 (interquartile range, 9Y16). More than 50% of the patients had a low-risk GAP or MGAP score (1% mortality). With regard to discrimination, areas under the ROC curve were 87.2% for GAP score (95% confidence interval, 86.7Y87.7) and 86.8% for MGAP score (95% confidence interval, 86.2Y87.3). With regard to calibration, 2,390 (3.3%), 1,900 (28.5%), and 1,184 (72.2%) patients died in the low, medium, and high GAP risk categories, respectively. In the low-and medium-risk groups, these were almost double the previously published rates. For MGAP, 1,861 (2.8%), 1,455 (15.2%), and 2,158 (58.6%) patients died in the low-, medium-, and high-risk categories, consonant with results originally published. Reclassifying score point cutoffs improved likelihood ratios, sensitivity and specificity, as well as areas under the ROC curve. CONCLUSION:We found both scores to be valid triage tools to stratify emergency department patients, according to their risk of death. MGAP calibrated better, but GAP slightly improved discrimination. The newly proposed cutoffs better differentiate risk classification and may therefore facilitate hospital resource allocation. (J Trauma Acute Care Surg. 2014;77: 757Y763.

show abstract

The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients

Cited by 13 publications

References 33 publications

External validation of the Glasgow coma scale-pupils in low- to middle-income country patients with traumatic brain injury: Could “motor score-pupil” have higher prognostic value?

External validation of the Glasgow coma scale-pupils in low- to middle-income country patients with traumatic brain injury: Could “motor score-pupil” have higher prognostic value?

Predicting Mortality from Head Injury: Experience of Sancti Spíritus Province, Cuba

Validation and reclassification of MGAP and GAP in hospital settings using data from the Trauma Audit and Research Network

Contact Info

Product

Resources

About