Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity Article Swipe
Paul M. Brennan
,
Gordon Murray
,
Graham M. Teasdale
·
YOU?
·
· 2018
· Open Access
·
· DOI: https://doi.org/10.3171/2017.12.jns172780
YOU?
·
· 2018
· Open Access
·
· DOI: https://doi.org/10.3171/2017.12.jns172780
OBJECTIVE Glasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this. METHODS Information about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis. Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3–15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1–15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke’s R 2 . RESULTS Separately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P. CONCLUSIONS A simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3171/2017.12.jns172780
- https://thejns.org/downloadpdf/journals/j-neurosurg/128/6/article-p1612.pdf
- OA Status
- bronze
- Cited By
- 189
- References
- 32
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2797706301
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W2797706301Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.3171/2017.12.jns172780Digital Object Identifier
- Title
-
Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severityWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2018Year of publication
- Publication date
-
2018-04-10Full publication date if available
- Authors
-
Paul M. Brennan, Gordon Murray, Graham M. TeasdaleList of authors in order
- Landing page
-
https://doi.org/10.3171/2017.12.jns172780Publisher landing page
- PDF URL
-
https://thejns.org/downloadpdf/journals/j-neurosurg/128/6/article-p1612.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
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https://thejns.org/downloadpdf/journals/j-neurosurg/128/6/article-p1612.pdfDirect OA link when available
- Concepts
-
Glasgow Coma Scale, Medicine, Pupil, Traumatic brain injury, Glasgow Outcome Scale, Head injury, Internal medicine, Surgery, Psychiatry, Psychology, NeuroscienceTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
189Total citation count in OpenAlex
- Citations by year (recent)
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2025: 19, 2024: 48, 2023: 24, 2022: 26, 2021: 29Per-year citation counts (last 5 years)
- References (count)
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32Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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