Application and clinical utility of the Glasgow Coma Scale over time: A study employing the NIDRR traumatic Brain Injury Model Systems database

Marie D. Barker, John Whyte, Christopher R. Pretz, Mark Sherer, Nancy Temkin, Flora Hammond, Zabedah Saad, Thomas Novack

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)400-406
Number of pages7
JournalJournal of Head Trauma Rehabilitation
Volume29
Issue number5
DOIs
StatePublished - Sep 1 2014

Fingerprint

Glasgow Coma Scale
Databases
Intubation
Paralysis
Brain Injuries
Traumatic Brain Injury
Hypnotics and Sedatives
Hospital Emergency Service
Emergencies
Rehabilitation
Retrospective Studies

Keywords

  • Glasgow Coma Scale
  • Intubation
  • Outcome prediction
  • Traumatic Brain Injury

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Application and clinical utility of the Glasgow Coma Scale over time : A study employing the NIDRR traumatic Brain Injury Model Systems database. / Barker, Marie D.; Whyte, John; Pretz, Christopher R.; Sherer, Mark; Temkin, Nancy; Hammond, Flora; Saad, Zabedah; Novack, Thomas.

In: Journal of Head Trauma Rehabilitation, Vol. 29, No. 5, 01.09.2014, p. 400-406.

Research output: Contribution to journalArticle

Barker, Marie D. ; Whyte, John ; Pretz, Christopher R. ; Sherer, Mark ; Temkin, Nancy ; Hammond, Flora ; Saad, Zabedah ; Novack, Thomas. / Application and clinical utility of the Glasgow Coma Scale over time : A study employing the NIDRR traumatic Brain Injury Model Systems database. In: Journal of Head Trauma Rehabilitation. 2014 ; Vol. 29, No. 5. pp. 400-406.
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