Those who speak survive: the value of the verbal component of GCS in trauma

To evaluate the value of the individual components of GCS in predicting the survival of trauma patients in the Emergency Department.

Trauma patients who were admitted for more than 24 h or died after arrival at Al-Ain Hospital from January 2014 to December 2017 were studied. Children < 16 years, elderly > 80 years, patients with facial injuries, those intubated in the ER, and those with missing primary outcomes were excluded. Demography, vital signs, Glasgow Coma Scale (GCS), GCS components, Injury Severity Score (ISS), head AIS, and death were compared between those who died and those who survived. Factors with a p value of < 0.1 were entered into a backward likelihood logistic regression model to define factors that predict death.

A total of 2548 patients were studied, out of whom 11 (0.4%) died. The verbal component of GCS (p < 0.001) and the ISS (p = 0.047) were the only significant predictors for death in the logistic regression model. The AUC (95% CI) of the GCS-VR was 0.763 (0.58-0.95), p = 0.003. The best point of GCS-VR that predicted survival was 5, having a sensitivity of 97%, a specificity of 54.5%, positive predictive value of 99. 8%, negative predictive value of 7.3%, and likelihood ratio of 2.13.

In general trauma patients, acute trauma care professionals can use GCS-VR to predict survival when clinical condition permits instead of the total GCS score or ISS.