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Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale
Fares Komboz1, Hiba Douja Chehade1,2, Bilal Al Saffar1
1Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37075, Germany.
Background:
The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Score (HS), a novel tool designed to incorporate radiological data, offers a promising approach to predicting TBI outcomes. This study aims to evaluate the prognostic efficacy of HS in comparison to GCS across a substantial TBI patient cohort.
Methods:
This retrospective study encompassed TBI patients treated at our institution between 2008 and 2019, specifically those with an admission GCS of 14 or lower. We assessed both the initial GCS and the HS derived from primary CT scans. Key outcome metrics included the Glasgow Outcome Scale (GOS) and mortality rates at hospital discharge and at 6 and 12-month intervals post-discharge. Predictive performances of GCS and HS were analyzed through Receiver Operating Characteristic (ROC) curves and Kendall tau-b correlation coefficients against each outcome.
Results:
The study included 544 patients, with an average age of 62.2 ± 21.5 years, median initial GCS of 14, and a median HS of 3. The mortality rate at discharge stood at 8.6%, with a median GOS of 4. Both GCS and HS demonstrated significant correlations with mortality and GOS outcomes (p < 0.05). Notably, HS showed a markedly superior correlation with mortality (τb = 0.36) compared to GCS (τb = -0.11) and with GOS outcomes (τb = -0.40 for HS vs. τb = 0.33 for GCS). ROC analyses affirmed HS's enhanced predictive accuracy over GCS for both mortality (AUC of 0.79 for HS vs. 0.62 for GCS) and overall outcomes (AUC of 0.77 for HS vs. 0.71 for GCS).
Conclusion:
The findings validate the HS in a large German cohort and suggest that radiological assessments alone, as exemplified by HS, can surpass the traditional GCS in predicting TBI outcomes. However, the HS, despite its efficacy, lacks the integration of clinical evaluation, a vital component in TBI management. This underscores the necessity for a holistic approach that amalgamates both radiological and clinical insights for a more comprehensive and accurate prognostication in TBI care.
