Validation of a Practical Method for Estimating Total Glasgow Coma Scale Scores in Intubated Traumatic Brain Injury...

Area of Science:

• Neurology
• Critical Care Medicine
• Trauma Surgery

Background:

• Traumatic brain injury (TBI) presents a significant global health challenge, contributing to high mortality and long-term disability.
• The Glasgow Coma Scale (GCS) is crucial for TBI severity assessment but is less reliable in intubated patients due to the inability to assess verbal responses.

Purpose of the Study:

• To validate a practical method for estimating total GCS (etGCS) scores in intubated TBI patients.
• To assess the reliability of etGCS when integrated into established intensive care unit (ICU) severity scoring systems.

Main Methods:

• A retrospective cohort study utilizing data from the MIMIC-IV database.
• Evaluation of etGCS reliability through association with in-hospital mortality and performance within existing ICU scoring systems.
• Application of multiple statistical approaches for robust validation.

Main Results:

• The etGCS demonstrated consistent reliability in predicting in-hospital mortality among 886 intubated TBI patients (AUC: 68.22%).
• Integration with pupillary assessment (etGCS-P) maintained stable predictive performance (AUC: 71.99%).
• The etGCS reliably enhanced established severity scoring systems, with its removal decreasing predictive performance.

Conclusions:

• A practical and reliable method for estimating GCS scores in intubated TBI patients has been validated.
• The etGCS offers consistent predictive value for mortality and improves existing ICU severity scoring systems.
• This method supports accurate patient assessment, clinical communication, and informed care decisions for intubated TBI patients.