Inclusion of Highest Glasgow Coma Scale Motor Component Score in Mortality Risk Adjustment for Benchmarking of Trauma...

Area of Science:

• Trauma care and critical illness research
• Neurological assessment and outcomes
• Health services research and quality improvement

Background:

• The Glasgow Coma Scale (GCS) motor component (mGCS) is crucial for assessing traumatic brain injury (TBI) severity.
• Current risk-adjustment models primarily use the initial mGCS score for external benchmarking.
• Emerging evidence suggests the highest mGCS score within 24 hours may be a superior predictor of mortality.

Purpose of the Study:

• To evaluate the impact of incorporating the highest mGCS score on risk-adjustment model performance.
• To assess how including the highest mGCS score affects external benchmarking results for trauma centers.
• To determine if the highest mGCS score enhances the prediction of mortality in severe TBI patients.

Main Methods:

• Analysis of the Trauma Quality Improvement Program dataset (January 2014-March 2015).
• Inclusion of severe TBI patients (≥16 years, isolated head injury, GCS ≤8).
• Development of risk-adjustment models comparing initial mGCS, highest mGCS, and both scores.

Main Results:

• Significant differences between initial and highest mGCS scores observed in 47% of 6,553 severe TBI patients.
• Models incorporating both initial and highest mGCS scores demonstrated improved performance and fit (C-statistic, AIC, adjusted R-squared).
• Inclusion of highest mGCS score led to substantial shifts in adjusted odds ratios and outlier status for many trauma centers.

Conclusions:

• The highest mGCS score is a valuable predictor of mortality in severe TBI.
• Integrating additional clinical data, like the highest mGCS score, enhances risk-adjustment models.
• This approach can meaningfully improve external benchmarking strategies and trauma center performance evaluation.