Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients.

Abstract

BACKGROUND:

Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients.

OBJECTIVE:

We evaluated the accuracy of the GCS-Pupil score (GCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining GCS and pupil response with additional clinical and radiological prognostic factors.

METHODS:

Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of GCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the GCS-P score by multivariate binary logistic regression.

RESULTS:

Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the GCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The GCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies.

CONCLUSION:

Our results support the external validation of the GCS-P to predict hospital mortality following a severe TBI. The predictive value of the GCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

• Authors: Melina Moré Bertotti, Evandro Tostes Martins, Fernando Zanela Areas, Helena Dresch Vascouto, Norma Beatriz Rangel, Hiago Murilo Melo, Katia Lin, Emil Kupek, Felipe Dal Pizzol, Alexandra J Golby, Roger Walz
• Journal: Arquivos de neuro-psiquiatria (Arq Neuropsiquiatr) Vol. 81 Issue 5 Pg. 452-459 (05 2023) ISSN: 1678-4227 [Electronic] Germany
• Vernacular Title: Escala de coma de Glasgow com resposta pupilar (ECG-P) e mortalidade hospitalar em traumatismo cranioencefálico grave: análise de 1.066 pacientes brasileiros.
• PMID: 37257465 (Publication Type: Journal Article)
• Copyright: Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).

Topics

• Male
• Humans
• Adult
• Female
• Glasgow Coma Scale
• Pupil
• Prospective Studies
• Hospital Mortality
• Brazil
• Brain Injuries, Traumatic (diagnostic imaging)
• Prognosis