Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score
Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score
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DOI：
10.1089/neu.2021.0199
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发表时间：
2021-12-01
影响因子：
4.2
通讯作者：
Edlow, Brian L.
中科院分区：
文献类型：
--
作者：
Bodien, Yelena G.;Barra, Alice;Edlow, Brian L.
在几乎所有的临床和研究背景下，创伤性脑损伤（TBI）的初始严重程度是使用格拉斯哥昏迷量表（GCS）总分来衡量的。然而，GCS总分可能不能准确反映意识水平，这是损伤严重程度的关键指标。作为TBI多中心转化研究和临床知识（TRACK-TBI）研究的一部分，我们对2455名连续样本进行了69,487次GCS评估，研究了GCS总分与意识水平之间的关系。我们根据以下意识障碍（DoC）诊断的公开标准为每个GCS子量表评分组合分配了一个意识等级：昏迷、植物人状态/无反应性清醒综合征、最低意识状态和创伤后混乱状态，并通过汇总统计和四个说明性病例介绍了我们的发现。参与者具有以下特征：平均（标准差）年龄41.9（17.6）岁，69%为男性，初始GCS 3-8 = 13%；9-12 = 5%；13-15 = 82%。所有GCS总分在4-14分之间的患者均与不止一种DoC诊断相关；7-11分之间的差异最大。此外，大范围的总分与相同的DoC诊断相关。重要的是，昏迷的诊断只有在GCS总分为3-6分时才有可能。GCS总分不能准确反映基于已公布的DoC诊断标准的意识水平。为了改善TBI患者的分类，并为未来临床试验的设计提供信息，临床医生和研究者在评估TBI严重程度时应考虑个体亚量表行为和更全面的评估。
In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured using the Glasgow Coma Scale (GCS) total score. The GCS total score however, may not accurately reflect level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS total scores and level of consciousness in a consecutive sample of 2455 adult subjects assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We assigned each GCS subscale score combination a level of consciousness rating based on published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3-8 = 13%; 9-12 = 5%; 13-15 = 82%. All GCS total scores between 4-14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7-11. Further, a wide range of total scores was associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3-6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity.