Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients
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 mo...
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Thieme Revinter Publicações
2023-05-01
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| Series: | Arquivos de Neuro-Psiquiatria |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1768671 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Melina Moré Bertotti |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-99a3ef92a783448fb16e72a4f47dcdf8 |
| institution | Kabale University |
| issn | 0004-282X 1678-4227 |
| language | English |
| publishDate | 2023-05-01 |
| publisher | Thieme Revinter Publicações |
| record_format | Article |
| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj-art-99a3ef92a783448fb16e72a4f47dcdf82025-08-20T03:36:48ZengThieme Revinter PublicaçõesArquivos de Neuro-Psiquiatria0004-282X1678-42272023-05-01810545245910.1055/s-0043-1768671Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patientsMelina Moré Bertotti0Evandro Tostes Martins1Fernando Zanela Areas2Helena Dresch Vascouto3Norma Beatriz Rangel4Hiago Murilo Melo5Katia Lin6Emil Kupek7Felipe Dal Pizzol8Alexandra J. Golby9Roger Walz10Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.Hospital Governador Celso Ramos, Unidade de Terapia Intensiva, Florianópolis SC, Brazil.Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.Hospital Universitário Polydoro Ernani de São Thiago, Departamento de Clínica Médica, Serviço de Neurologia, Florianópolis SC, Brazil.Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Florianópolis SC, Brazil.Universidade do Sul de Santa Catarina, Laboratório Experimental de Patofisiologia, Programa de Pós-Graduação em Ciências da Saúde, Criciúma SC, Brazil.Harvard Medical School, Brigham and Women's Hospital, Department of Neurosurgery, Boston MA, United States.Universidade Federal de Santa Catarina, Centro de Neurociências Aplicadas, Florianópolis SC, Brazil.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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1768671glasgow coma scalepupilbrain injuriestraumaticprognosismortality |
| spellingShingle | 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 Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients Arquivos de Neuro-Psiquiatria glasgow coma scale pupil brain injuries traumatic prognosis mortality |
| title | Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients |
| title_full | Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients |
| title_fullStr | Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients |
| title_full_unstemmed | Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients |
| title_short | Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients |
| title_sort | glasgow coma scale pupil score gcs p and the hospital mortality in severe traumatic brain injury analysis of 1 066 brazilian patients |
| topic | glasgow coma scale pupil brain injuries traumatic prognosis mortality |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1768671 |
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