A comparison of the Glasgow coma scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes
A comparison of the Glasgow coma scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes
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DOI：
10.1016/j.annemergmed.2004.07.429
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发表时间：
2005-01-01
影响因子：
6.2
通讯作者：
Green, SM
中科院分区：
文献类型：
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作者：
Gill, M;Windemuth, R;Green, SM
研究目的：15分制格拉斯哥昏迷量表（GCS）广泛用于急诊科（艾德）环境中创伤性脑损伤的初步评估。我们假设，GCS可能是不必要的复杂性，一个简单的评分系统可能会表现出类似的准确性在预测创伤性脑损伤outcomes.Methods：我们分析了前瞻性维持创伤登记册的患者在我们的1级创伤中心评价，从1990年至2002年。我们计算了艾德GCS评分相对于4个临床相关创伤性脑损伤结局（紧急插管、神经外科干预、脑损伤和死亡率）的测试性能，使用其受试者工作特征（ROC）曲线下的面积。我们对GCS的3个组成部分和2个简化的3分评分进行了类似的分析（简化的语言评分：定向=2，混乱的对话=1，不适当的话或更少=0;简化的运动评分：服从命令=2，局部疼痛=1，退缩到疼痛或更少=0）。然后，我们比较了这5个总GCS评分使用先验阈值为临床上重要的differentiation.Results的测试性能：3个GCS组件单独和2个简化的3点分数证明ROC面积在9%的GCS评分的4个结果，中位数差异为3.0%（四分位数范围1.6%至4.5%）。这些差异都低于我们的先验定义的clinical important.Conclusion：3个单独的GCS组件和两个3点简化的分数表现出测试性能相似的GCS总分预测4临床相关的创伤性脑损伤的结果。尽管GCS广泛用于创伤性脑损伤的初步评估，但该评分对于该适应症来说可能过于复杂。
Study objective: The 15-point Glasgow Coma Scale (GCS) is extensively used in the initial evaluation of traumatic brain injury in emergency department (ED) settings. We hypothesized that the GCS might be unnecessarily complex and that a simpler scoring system might demonstrate similar accuracy in the prediction of traumatic brain injury outcomes.Methods: We analyzed a prospectively maintained trauma registry of patients evaluated at our Level 1 trauma center from 1990 to 2002. We calculated the test performance of ED GCS scores relative to 4 clinically relevant traumatic brain injury outcomes (emergency intubation, neurosurgical intervention, brain injury, and mortality) using areas under their receiver operating characteristic (ROC) curves. We performed similar analyses for each of the 3 GCS components and for 2 simplified 3-point scores (simplified verbal score: oriented=2, confused conversation=1, inappropriate words or less=0; simplified motor score: obeys commands=2, localizes pain=1, withdrawal to pain or less=0). We then compared the test performance of each of these 5 to the total GCS score using a priori thresholds for clinically important differences.Results: Each of the 3 GCS components alone and the 2 simplified 3-point scores demonstrated ROC areas within 9% of that of the GCS score for the 4 outcomes, with a median difference of 3.0% (interquartile range 1.6% to 4.5%). These differences were all below our a priori definitions of clinical importance.Conclusion: The 3 individual GCS components alone and two 3-point simplified scores demonstrated test performance similar to the total GCS score for the prediction of 4 clinically relevant traumatic brain injury outcomes. Despite the widespread use of the GCS for the initial evaluation of traumatic brain injury, this score may be unnecessarily complex for this indication.