The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better
UMass Chan Affiliations
Department of Anesthesiology/Critical CareDepartment of Surgery
Department of Neurology
Document Type
Journal ArticlePublication Date
2017-04-15Keywords
Glasgow Coma Scaleestimated verbal GCS
motor GCS
outcome prognostication
traumatic brain injury
UMCCTS funding
Diagnosis
Health Services Administration
Nervous System Diseases
Neurology
Pathological Conditions, Signs and Symptoms
Translational Medical Research
Trauma
Metadata
Show full item recordAbstract
The Glasgow Coma Scale (GCS) has limited utility in intubated patients due to the inability to assign verbal subscores. The verbal subscore can be derived from the eye and motor subscores using a mathematical model, but the advantage of this method and its use in outcome prognostication in traumatic brain injury (TBI) patients remains unknown. We compared the validated "Core+CT"-IMPACT-model performance in 251 intubated TBI patients prospectively enrolled in the longitudinal OPTIMISM study between November 2009 and May 2015 when substituting the original motor GCS (mGCS) with the total estimated GCS (teGCS; with estimated verbal subscore). We hypothesized that model performance would improve with teGCS. Glasgow Outcome Scale (GOS) scores were assessed at 3 and 12 months by trained interviewers. In the complete case analysis, there was no statistically or clinically significant difference in the discrimination (C-statistic) at either time-point using the mGCS versus the teGCS (3 months: 0.893 vs. 0.871;12 months: 0.926 vs. 0.92). At 3 months, IMPACT-model calibration was excellent with mGCS and teGCS (Hosmer-Lemeshow "goodness-of-fit" chi square p value 0.9293 and 0.9934, respectively); it was adequate at 12 months with teGCS (0.5893) but low with mGCS (0.0158), possibly related to diminished power at 12 months. At both time-points, motor GCS contributed more to the variability of outcome (Nagelkerke DeltaR(2)) than teGCS (3 months: 5.8% vs. 0.4%; 12 months: 5% vs. 2.6%). The sensitivity analysis with imputed missing outcomes yielded similar results, with improved calibration for both GCS variants. In our cohort of intubated TBI patients, there was no statistically or clinically meaningful improvement in the IMPACT-model performance by substituting the original mGCS with teGCS.Source
J Neurotrauma. 2017 Apr 15;34(8):1603-1609. doi: 10.1089/neu.2016.4657. Epub 2016 Dec 2. Link to article on publisher's site
DOI
10.1089/neu.2016.4657Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50350PubMed ID
27774844Related Resources
ae974a485f413a2113503eed53cd6c53
10.1089/neu.2016.4657