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Citation |
Lesko MM, Jenks T, O'Brien S, Childs C, Bouamra O, Woodford M, Lecky F. J. Neurotrauma 2013; 30(1): 17-22. |
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Affiliation |
Unversity of Manchester, The Trauma Audit and Research Network (TARN), Salford , United Kingdom; MehdiMLesko@gmail.com. |
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Copyright |
(Copyright © 2013, Mary Ann Liebert Publishers) |
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DOI |
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PMID |
22931390 |
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Abstract |
The Glasgow Coma Scale (GCS) score is used in clinical practice for patient assessment and communication amongst clinicians and also in outcome prediction models such as the Trauma Injury and Injury Severity Score (TRISS). The objective of this study is to determine which GCS subscore is best associated with outcome taking time of assessment into account. Records of patients with brain injury presenting after 1989 were extracted from the Trauma Audit and Research Network (TARN) database. Using logistic regression, a baseline model was derived with age, Injury Severity Score (ISS) and year of injury as covariates and survival at discharge as the dependent variable. Total GCS, its subscores and their combinations at various time points were separately added to the baseline model in order to compare their effect on model performance. The dataset contained 21,657 cases. The total GCS score at scene and its subscores had significantly lower predictive power compared with those recorded on arrival at Emergency Department (ED) (scene total GCS: AUC: 0.89 (95% CI: 0.89-0.90) and Nagelkerke R2 of 0.55, admission total GCS: AUC of 0.91(95% CI: 0.91-0.91) and Nagelkerke R2 of 0.59). Eye and verbal subscores had significantly lower performances compared with total GCS, motor subscore and various combinations of subscores. Motor subscore and total GCS appeared to have similar predictive performance (admission total and motor GCS both had AUC of 0.91 (95% CI: 0.91-0.92) and Nagelkerke R2 of 0.59 and 0.58 respectively). Motor subscore contains most of the predictive power of the total score. GCS on arrival is a significantly better predictor of outcome than that recorded at scene. Language: en |