The differential mortality of Glasgow Coma Score in patients with and without head injury |
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| Affiliation: | 1. Department of Surgery, University of Vermont, 789 Orchard Shore Road, Colchester, VT 05446, United States;2. Trauma Research Program, Chandler Regional Medical Center, United States;3. Department of Surgery University of Arizona College of Medicine, Phoenix, United States;4. Department of Anesthesiology, University of Rochester, United States;5. Emergency Medicine, University of Sheffield, United Kingdom;6. Trauma Audit and Research Network, United Kingdom;7. Chandler Regional Medical Center, United States;8. Department of Mathematics and Statistics, University of Vermont, United States;9. School of Public Health and Health Sciences, University of Massachusetts, United States;1. Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey;2. Department of Cardiovascular Surgery, Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey;3. Department of Cardiovascular Surgery, Antakya State Hospital, Hatay, Turkey;4. Department of Cardiovascular Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey;7. Burn Centre Beverwijk, Beverwijk, The Netherlands;8. Burn Centre Rotterdam, Rotterdam, The Netherlands;9. Burn Centre Groningen, Groninge, The Netherlands;10. Association of Dutch Burn Centres, Groningen, The Netherlands;1. Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands;2. Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands;3. Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands;4. Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands;5. Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands;6. Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands;1. Network Emergency Care Brabant, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands;2. Department of Surgery, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands;3. CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands;4. Department of Orthopaedics, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands;5. Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands;6. Department of Medical Psychology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands;1. Departments of Surgery, University of Calgary, Calgary, AB, Canada;2. Departments of Surgery, University of California, San Francisco, CA, USA;3. Departments of Surgery, University of Maryland, Baltimore, MD, USA |
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| Abstract: | ImportanceThe GCS was created forty years ago as a measure of impaired consciousness following head injury and thus the association of GCS with mortality in patients with traumatic brain injury (TBI) is expected. The association of GCS with mortality in patients without TBI (non-TBI) has been assumed to be similar. However, if this assumption is incorrect mortality prediction models incorporating GCS as a predictor will need to be revised.ObjectiveTo determine if the association of GCS with mortality is influenced by the presence of TBI.Design/setting/participantsUsing the National Trauma Data Bank (2012; N = 639,549) we categorized patients as isolated TBI (12.8%), isolated non-TBI (33%), both (4.8%), or neither (49.4%) based on the presence of AIS codes of severity 3 or greater. We compared the ability GCS to discriminate survivors from non-survivors in TBI and in non-TBI patients using logistic models. We also estimated the odds ratios of death for TBI and non-TBI patients at each value of GCS using linear combinations of coefficients.Main outcome measureDeath during hospital admission.ResultsAs the sole predictor in a logistic model GCS discriminated survivors from non-survivors at an acceptable level (c-statistic = 0.76), but discriminated better in the case of TBI patients (c-statistic = 0.81) than non-TBI patients (c-statistic = 0.70). In both unadjusted and covariate adjusted models TBI patients were about twice as likely to die as non-TBI patients with the same GCS for GCS values < 8; for GCS values > 8 TBI and non-TBI patients were at similar risk of dying.ConclusionsA depressed GCS predicts death better in TBI patients than non-TBI patients, likely because in non-TBI patients a depressed GCS may simply be the result of entirely reversible intoxication by alcohol or drugs; in TBI patients, by contrast, a depressed GCS is more ominous because it is likely due to a head injury with its attendant threat to survival. Accounting for this observation into trauma mortality datasets and models may improve the accuracy of outcome prediction. |
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| Keywords: | Glasgow Coma Score Traumatic brain injury Mortality Logistic |
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