Application and clinical utility of the Glasgow Coma Scale over time: A study employing the NIDRR Traumatic Brain Injury Model Systems database

Short Title:
Application and clinical utility of the Glasgow Coma Scale over time: A study employing the NIDRR Traumatic Brain Injury Model Systems database
Model System:
Burn
Reference Type:
Journal Article
Accession No.:
J69858
Journal:
Journal of Head Trauma Rehabilitation
Year, Volume, Issue, Page(s):
2015, vol. 1, issue 29, pp 400-406
Publication Website:
Abstract:
Study examined 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. The GCS is the most commonly used index of traumatic brain injury (TBI) severity. Participants were 1,228 patients enrolled in the Traumatic Brain Injury Model Systems national database, a multicenter longitudinal study of TBI funded by the National Institute on Disability and Rehabilitation Research (NIDRR). GCS scores were 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). The Functional Independence Measure (FIM) was assessed at rehabilitation admission. Linear regression evaluated the ability of GCS to predict FIM. Analyses revealed that the rate of intubation prior to GCS scoring averaged 43 percent and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27 percent of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69 percent of intubated patients as severely brain injured and 8 percent as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability in FIM scores during most epochs. There is no evidence for declining predictive utility of the GCS over time.
Author(s):
Lee A, Ryan CM, Kazis LE, Schneider JC, Meyer W, Palmieri T, Pidcock F, Reilly D, Sheridan RL, Tompkins RG
Author Address(es):

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