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 language | English |
|---|---|
| Pages (from-to) | 400-406 |
| Number of pages | 7 |
| Journal | Journal of Head Trauma Rehabilitation |
| Volume | 29 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 1 2014 |
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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 journal › Article
}
TY - JOUR
T1 - Application and clinical utility of the Glasgow Coma Scale over time
T2 - A study employing the NIDRR traumatic Brain Injury Model Systems database
AU - Barker, Marie D.
AU - Whyte, John
AU - Pretz, Christopher R.
AU - Sherer, Mark
AU - Temkin, Nancy
AU - Hammond, Flora
AU - Saad, Zabedah
AU - Novack, Thomas
PY - 2014/9/1
Y1 - 2014/9/1
N2 - 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.
AB - 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.
KW - Glasgow Coma Scale
KW - Intubation
KW - Outcome prediction
KW - Traumatic Brain Injury
UR - http://www.scopus.com/inward/record.url?scp=84925969920&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84925969920&partnerID=8YFLogxK
U2 - 10.1097/HTR.0b013e31828a0a45
DO - 10.1097/HTR.0b013e31828a0a45
M3 - Article
C2 - 23535391
AN - SCOPUS:84925969920
VL - 29
SP - 400
EP - 406
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
SN - 0885-9701
IS - 5
ER -