Can Glasgow Coma Scale Predict Brain Injury?

TOPLINE:

The prehospital Glasgow Coma Scale (GCS) fails to diagnose traumatic brain injury (TBI) in patients with hemorrhage and shock.

METHODOLOGY:

• Researchers performed a post hoc, secondary analysis using data from three randomized prehospital clinical trials: PAMPer, STAAMP, and PPOWER.
• A total of 1490 patients were included and categorized into two cohorts according to the diagnosis of TBI. They were further stratified on the basis of prehospital GCS scores into three groups: GCS 3, GCS 4-12, and GCS 13-15.
• The association between the prehospital GCS scores and clinical documentation of TBI in patients with severe injury and concomitant shock was assessed.

TAKEAWAY:

• The incidence of TBI was the highest in patients with a GCS score of 3 (59.5%), second highest in those with a GCS score of 4-12 (42.4%), and lowest in those with a GCS score of 13-15 (11.8%).
• A GCS score of 3 had a positive predictive value of 60% for diagnosing TBI, indicating its limited effectiveness in diagnosing the condition.
• Hypotension and prehospital intubation were independent predictors of a low GCS score, which was strongly associated with an increased incidence of mortality, regardless of TBI diagnosis.

IN PRACTICE:

“Prehospital GCS in patients at risk of hemorrhage and shock has a low positive predictive value for the diagnosis of TBI,” the authors wrote. “The use of novel scoring systems and improved technology are needed to promote the accurate diagnosis of TBI to provide prehospital interventions that ultimately improve outcomes for the severely injured,” they added.

SOURCE:

The study was led by Nidhi Iyanna, University of Pittsburgh, Pittsburgh, and was published online on August 6, 2024, in Prehospital Emergency Care.

LIMITATIONS:

The study’s limitations included the possibility of potential bias and confounding due to varying inclusion criteria, interventions, and time periods. The three trials did not represent the entire literature on GCS use for TBI diagnosis, and pathological diagnoses may have influenced the prehospital GCS results. The study was limited to a single prehospital GCS measurement and did not determine the timing of vital signs or prehospital interventions. Moderate degrees of interrater reliability may have limited the accuracy of the GCS scores.

DISCLOSURES:

This study did not receive any funding. The PAMPer, STAAMP, and PPOWER trials received funding from the US Army Medical Research and Materiel Command. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.