scholarly journals The Efficacy of Glasgow Coma Scale (GCS) Score and Acute Physiology and Chronic Health Evaluation (APACHE) II for Predicting Hospital Mortality of ICU Patients with Acute Traumatic Brain Injury

2018 ◽  
Vol 6 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Amir Nik ◽  
◽  
Mohammad Sobhan Sheikh Andalibi ◽  
Mohammad Reza Ehsaei ◽  
Ahmadreza Zarifian ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Chronic Health Evaluation ◽  
Health Evaluation ◽  
Icu Patients ◽  
Coma Scale ◽  
Acute Traumatic Brain Injury ◽  
Gcs Score

scholarly journals Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury

2015 ◽  
Vol 10 (2) ◽  
pp. 4-9
Author(s):  
SK Sah ◽  
ND Subedi ◽  
K Poudel ◽  
M Mallik
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Midline Shift ◽  
Female Ratio ◽  
Coma Scale ◽  
Acute Traumatic Brain Injury ◽  
Gcs Score

OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury attending in Chitwan Medical College teaching hospital Chitwan, Nepal.MATERIALS AND METHODS A cross-sectional study was performed among 50 patients of acute (less than24 hours) cases of craniocerebral trauma over a period of four months. The patient’s level of consciousness (GCS) was determined and a brain CT scan without contrast media was performed. A sixth generation General Electric (GE) CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.RESULT The age range of the patients was 1 to 75 years (mean age 35.6± 21.516 years) and male: female ratio was 3.1:1. The most common causes of head injury were road traffic accident (RTA) (60%), fall injury (20%), physical assault (12%) and pedestrian injuries (8%). The distribution of patients in accordance with consciousness level was found to be 54% with mild TBI (GCS score 12 to 14), 28% with moderate TBI (GCS score 11 to 8) and 18% with severe TBI (GCS score less than 7). The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan was accompanied by lower GCS.CONCLUSION The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan were accompanied with lower GCS. Patients having single lesion had more GCS level than mixed level and mid line shift type of injury.Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 4-9

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

2020 ◽  
Vol 37 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Amit Kochar ◽  
Meredith L Borland ◽  
Natalie Phillips ◽  
Sarah Dalton ◽  
John Alexander Cheek ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decision Rules ◽  
Secondary Analysis ◽  
Clinical Decision ◽  
Important Indicator ◽  
Coma Scale ◽  
Gcs Score

ObjectiveHead injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.MethodsPlanned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.ResultsOf 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).ConclusionsOutside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.

scholarly journals Correlation of Glasgow Coma Scale with Non-Contrast Computed Tomography findings in immediate post traumatic brain injury

2019 ◽  
Vol 7 (4) ◽  
pp. 1059
Author(s):  
Basudev Agrawal ◽  
Rupesh Verma
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Age Group ◽  
Female Ratio ◽  
Coma Scale ◽  
Gcs Score

Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.

scholarly journals Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

2014 ◽  
Vol 41 (4) ◽  
pp. 256-262 ◽  
Author(s):  
Nelson Saade ◽  
José Carlos Esteves Veiga ◽  
Luiz Fernando Cannoni ◽  
Luciano Haddad ◽  
João Luiz Vitorino Araújo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Csf Leak ◽  
Pupillary Reflex ◽  
Coma Scale ◽  
Intracranial Lesions ◽  
Gcs Score

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.

scholarly journals Traumatic Brain Injury: Prognostic Value of Various Coma Scales, CT Scores & Their Comparison Based on Clinical Outcome

2021 ◽  
Vol 6 (3) ◽  
pp. 26-30
Author(s):  
Ashrit Reddy Cheruku ◽  
Suryanarayan Reddy V
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Group Iv ◽  
Coma Scale ◽  
Group I ◽  
Highly Sensitive ◽  
Four Score ◽  
Group Ii ◽  
Gcs Score

Background: Traumatic brain injury (TBI) is common, carries a high morbidity and mortality and has no specific treatment. The Glasgow coma scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury against which other scale are compared to overcome the disadvantages of GCS. Materials & Methods: This is Prospective Observational comparative study was conducted in total 128 who admitted with traumatic brain injury (TBI) in Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during the period from November 2016 to November 2018. Results: A total of 128 (112 males) patients were included in the study. Among SMS, 0 is highly sensitive (72.22%), 2 is highly specific (80.43%). In GCS score < 8 was highly sensitive (97.22%) & GCS score 9 - 12 was highly specific (82.61%). In this study Marshall CT score of 4 - 6 (group II) has mortality 43.55% & CT score 1 - 3 (group I) was 13.64%. Where as in Rotterdam CT score was significant mortality with score 4 - 6 (group II) was 56.25% & CT score of 1 - 3 (group I) was 24.11%. In FOUR score with GCS, on 1 day with FOUR score 13 - 16 (group IV) has 5.56%, day 3, 13 - 16 (group IV) has 3.45%, day 7, 13 - 16 (group IV) has 3.13% & day 21, 13 - 16 (group IV) only 3.45% has mortality rate. Conclusion: if SMS is high there is more chance of survival, this helps in patients immediate segregation of patients in casualty. Also conclude that FOUR score has a high degree of internal consistency & is an accurate predictor of Mortality and neurologic outcome in TBI patients. Keywords: Simplified Motor Score, Glasgow Coma Scale, Marshall CT, Rotterdam CT, FOUR scale.

scholarly journals Incorporating age improves the Glasgow Coma Scale score for predicting mortality from traumatic brain injury

2021 ◽  
Vol 6 (1) ◽  
pp. e000641
Author(s):  
Kristin Salottolo ◽  
Ripul Panchal ◽  
Robert M Madayag ◽  
Laxmi Dhakal ◽  
William Rosenberg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Data Bank ◽  
Prognostic Indicator ◽  
Validation Dataset ◽  
Level Of Evidence ◽  
Coma Scale ◽  
Final Population ◽  
Gcs Score

BackgroundThe Glasgow Coma Scale (GCS) score has been adapted into categories of severity (mild, moderate, and severe) and are ubiquitous in the trauma setting. This study sought to revise the GCS categories to account for an interaction by age and to determine the discrimination of the revised categories compared with the standard GCS categories.MethodsThe American College of Surgeons National Trauma Data Bank registry was used to identify patients with traumatic brain injury (TBI; ICD-9 codes 850–854.19) who were admitted to participating trauma centers from 2010 to 2015. The primary exposure variables were GCS score and age, categorized by decade (teens, 20s, 30s…, 80s). In-hospital mortality was the primary outcome for examining TBI severity/prognostication. Logistic regression was used to calculate the conditional probability of death by age decade and GCS in a development dataset (75% of patients). These probabilities were used to create a points-based revision of the GCS, categorized as low (mild), moderate, and high (severe). Performance of the revised versus standard GCS categories was compared in the validation dataset using area under the receiver operating characteristic (AUC) curves.ResultsThe final population included 539,032 patients with TBI. Age modified the performance of the GCS, resulting in a novel categorization schema for each age decile. For patients in their 50s, performance of the revised GCS categories mirrored the standard GCS categorization (3–8, 9–12, 13–15); all other revised GCS categories were heavily modified by age. Model validation demonstrated the revised GCS categories statistically significantly outperformed the standard GCS categories at predicting mortality (AUC: 0.800 vs 0.755, p<0.001). The revised GCS categorization also outperformed the standard GCS categories for mortality within pre-specified subpopulations: blunt mechanism, isolated TBI, falls, non-transferred patients.DiscussionWe propose the revised age-adjusted GCS categories will improve severity assessment and provide a more uniform early prognostic indicator of mortality following traumatic brain injury.Level of evidenceIII epidemiologic/prognostic.

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