INTRODUCTION: The Glasgow Coma Score (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) to that recorded in the neurosurgery consultation (GCS-2).
METHODS: This retrospective review compared GCS-1 to GCS-2. The Trauma Injury Severity Score (TRISS) method was used to calculate probability of survival (POS) for patients using both GCS-1 and GCS-2.
RESULTS: GCS-1 significantly differed from GCS-2 (6.69 vs 7.84, ± 2.553, p<.001). There were 172 (37.55%) patients with a GCS-1 of 3 and 87 (19.00%) with a GCS-2 of 3 (Chi-square p<0.001). The probability of survival (POS) calculated using TRISS methodology with GCS-1 (POS-1) was 74.7% ± 26.6% compared to GCS-2 (POS-2), which was 79.3% ± 24.4%. There was a statistically significant difference in the means of POS-2 and POS-2 (p<0.001). The actual observed survival rate for the cohort was 71.0% (325/458).
CONCLUSION: The immediate GCS recorded on patient arrival after trauma differs significantly from the GCS recorded at later times. This significantly altered the probability of survival as calculated by the TRISS methodology. This could have profound effects on risk-adjusted benchmarking, assessments of quality of care and injury-severity stratification for research. More studies into the optimal timing of GCS recording or changes in GCS ant their impact on survival is warranted.
Language: en
Keywords
Traumatic Brain Injury; Glasgow Coma Score; Registry