Validation of the Simplified Motor Score for the Prediction of Brain Injury Outcomes After Trauma

Haukoos, Jason S.; Gill, Michelle; Rabon, Rick E.; Gravitz, Craig; Green, Steven M.

doi:10.1016/j.annemergmed.2006.10.004

Cited by 53 publications

(33 citation statements)

References 29 publications

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“…Recently, pre-hospital GCS scores were compared with its assessment in the ED, and poor agreement was found in patients with traumatic head injury and GCS sum scores <13 points [2]. This disagreement between emergency medical service and emergency physicians confirmed a number of earlier studies that found only good agreement in alert or near alert (GCS [13][14][15] patients [3,4]. Other observational studies found concerning disagreements between ED physicians and ED physicians and nurses when rating consciousness using the GCS [5,6], and marked differences between level I trauma centers in calculations of the GCS were found [7].…”

Section: Introductionmentioning

confidence: 73%

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Validation of a New Coma Scale, the FOUR Score, in the Emergency Department

et al. 2008

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Section: Introductionmentioning

confidence: 73%

“…Studies in the ED have not only involved validation of the scale, but also attempts at modifications (e.g., simplified motor scale) eliminating the eye and verbal response [15]. We would argue that further simplification of the GCS diminishes neurologic assessment despite better interrater reliability.…”

Section: Discussionmentioning

confidence: 99%

Validation of a New Coma Scale, the FOUR Score, in the Emergency Department

et al. 2008

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“…Thus, we found that the GCS verbal component was related to brain activity within neural networks that are likely to be involved in visual attention and the inhibition of pre-potent responses. Although the GCS motor component has often been reported to have a stronger relation with survival or overall level of disability (Al-Salamah, et al, 2004), other studies have found that the eye and verbal components are good predictors when they can be reliably obtained (Haukoos et al, 2007). Our finding that the GCS verbal score was specifically related to cognitive control induced brain activation may reflect that the transition to normal consciousness is graded on the verbal component of the GCS by resolution of confusion, a relatively late stage of the initial hospitalization when sedation has been lifted and patients are beginning to consistently follow commands, i.e., their motor scores have already approached a normal level.…”

Section: Relation Of Gcs Component Scores To Brain Activationmentioning

confidence: 99%

Effects of Severity of Traumatic Brain Injury and Brain Reserve on Cognitive-Control Related Brain Activation

Scheibel

Newsome

Troyanskaya

et al. 2009

Journal of Neurotrauma

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Functional magnetic resonance imaging (fMRI) has revealed more extensive cognitive-control related brain activation following traumatic brain injury (TBI), but little is known about how activation varies with TBI severity. Thirty patients with moderate to severe TBI and 10 with orthopedic injury (OI) underwent fMRI at 3 months postinjury using a stimulus response compatibility task. Regression analyses indicated that lower total Glasgow Coma Scale (GCS) and GCS verbal component scores were associated with higher levels of brain activation. Brain-injured patients were also divided into three groups based upon their total GCS score (3-4, 5-8, or 9-15), and patients with a total GCS score of 8 or less produced increased, diffuse activation that included structures thought to mediate visual attention and cognitive control. The cingulate gyrus and thalamus were among the areas showing greatest increases, and this is consistent with vulnerability of these midline structures in severe, diffuse TBI. Better task performance was associated with higher activation, and there were differences in the over-activation pattern that varied with TBI severity, including greater reliance upon left-lateralized brain structures in patients with the most severe injuries. These findings suggest that over-activation is at least partially effective for improving performance and may be compensatory.

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“…North-American studies (one Canadian and five American studies), reaching 0.89 when pre-hospital GCS values of victims cared for at a trauma referral center were analyzed (12,21,23) .…”

Section: Resultsmentioning

confidence: 99%

“…ROC is frequently used in studies to compare the performance of general and partial scores obtained in the GCS (eye opening, best verbal response, and best motor response) (12,14,23) . Analysis concerning the GCS discriminatory capacity is also performed to verify its performance at different times and to compare it in relation to other prognostic models, such as the Rev.…”

Section: Resultsmentioning

confidence: 99%

In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

Settervall

Sousa

Silva

2011

Rev. Latino-Am. Enfermagem

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This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scale's predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instrument's moderate discriminatory power.Descriptors: Brain Injuries; Trauma Severity Indices; Glasgow Coma Scale; Prognosis; Mortality. Escala de Coma de Glasgow en las primeras 72 horas postrauma encefalocraneano y mortalidad hospitalariaEl estudio tiene como objetivos verificar y comparar el desempeño de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos después de la atención inicial intra-hospitalaria, además de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de predicción de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 víctimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeño de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las áreas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la práctica clínica para estimar el pronóstico de las víctimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.

show abstract

Validation of the Simplified Motor Score for the Prediction of Brain Injury Outcomes After Trauma

Cited by 53 publications

References 29 publications

Validation of a New Coma Scale, the FOUR Score, in the Emergency Department

Validation of a New Coma Scale, the FOUR Score, in the Emergency Department

Effects of Severity of Traumatic Brain Injury and Brain Reserve on Cognitive-Control Related Brain Activation

In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

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