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Application and clinical utility of the Glasgow Coma Scale over time: a study employing the NIDRR traumatic brain
Marie D Barker1, John Whyte, Christopher R Pretz
1University of Alabama at Birmingham (Drs Barker and Novack); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Whyte); Craig Hospital (Dr Pretz) and Traumatic Brain Injury National Data and Statistical Center (Dr Pretz), Englewood, Colorado; TIRR Memorial Hermann, Houston, Texas (Dr Sherer); University of Washington, Seattle (Dr Temkin); Indiana University School of Medicine, Indianapolis (Dr Hammond); Carolinas Rehabilitation, Charlotte, North Carolina (Dr Hammond); and University of Northern Colorado, Greeley, Colorado (Ms Saad).
Objective:
To examine 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.
Participants:
10 228 patients from the Traumatic Brain Injury Model Systems national database.
Design:
Retrospective study examining 5-year epochs from 1987 to 2012.
Main Measures:
GCS score 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), Outcome: Functional Independence Measure (FIM) assessed at rehabilitation admission.
Results:
The rate of intubation prior to GCS scoring averaged 43% and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27% of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69% of intubated patients as severely brain injured and 8% as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability (approximately 5%-7%) in FIM scores during most epochs.
Conclusions:
Given the frequency of intubation and/or paralysis following brain injury in this sample, estimating GCS or exploring other means to gauge injury severity is beneficial, particularly because a portion likely did not sustain severe brain injury. There is no evidence for declining predictive utility of the GCS over time.
