@article{ref1,
title="Application and clinical utility of the Glasgow Coma Scale over time: a study employing the NIDRR Traumatic Brain Injury Model Systems Database",
journal="Journal of head trauma rehabilitation",
year="2013",
author="Barker, Marie D. and Whyte, John and Pretz, Christopher R. and Sherer, Mark and Temkin, Nancy and Hammond, Flora M. and Saad, Zabedah and Novack, Thomas",
volume="29",
number="5",
pages="400-406",
abstract="OBJECTIVE:: To examine possible changes in Glasgow Coma Scale (GCS) scores related to changes in emergency management, such as intubation and chemical paralysis, and the potential impact on outcome prediction. PARTICIPANTS:: 10 228 patients from the Traumatic Brain Injury Model Systems national database. DESIGN:: Retrospective study examining 5-year epochs from 1987 to 2012. MAIN MEASURES:: GCS score assessed in the Emergency Department (GCS scores for intubated, but not paralyzed, patients were estimated with a formula using 2 of the 3 GCS components), Outcome: Functional Independence Measure (FIM) assessed at rehabilitation admission. RESULTS:: The rate of intubation prior to GCS scoring averaged 43% and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27% of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69% of intubated patients as severely brain injured and 8% as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability (approximately 5%-7%) in FIM scores during most epochs. CONCLUSIONS:: Given the frequency of intubation and/or paralysis following brain injury in this sample, estimating GCS or exploring other means to gauge injury severity is beneficial, particularly because a portion likely did not sustain severe brain injury. There is no evidence for declining predictive utility of the GCS over time.<p /> <p>Language: en</p>",
language="en",
issn="0885-9701",
doi="10.1097/HTR.0b013e31828a0a45",
url="http://dx.doi.org/10.1097/HTR.0b013e31828a0a45"
}