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J Head Trauma Rehabil. 2014 Sep-Oct;29(5):400-6. doi: 10.1097/HTR.0b013e31828a0a45.

Application and clinical utility of the Glasgow Coma Scale over time: a study employing the NIDRR traumatic brain injury model systems database.

Author information

1
University of Alabama at Birmingham (Drs Barker and Novack); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Whyte); Craig Hospital (Dr Pretz) and Traumatic Brain Injury National Data and Statistical Center (Dr Pretz), Englewood, Colorado; TIRR Memorial Hermann, Houston, Texas (Dr Sherer); University of Washington, Seattle (Dr Temkin); Indiana University School of Medicine, Indianapolis (Dr Hammond); Carolinas Rehabilitation, Charlotte, North Carolina (Dr Hammond); and University of Northern Colorado, Greeley, Colorado (Ms Saad).

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.

PMID:
23535391
DOI:
10.1097/HTR.0b013e31828a0a45
[Indexed for MEDLINE]
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