Clinical indicators as prognostic factors of multi-trauma patients in the Intensive Care Unit

Background: In recent years, there has been a growing interest in understanding the role of prognostic factors in patient outcome.Aim: To investigate the role of clinical indicators, and severity-of-disease assessment scales, as prognostic factors in the outcome of multi-trauma patients in the ICU.Material and Method: The sample consisted of 65 ICU multi-trauma patients treated in a hospital in Thessaloniki city, with an average stay of 16.5 days. Clinical indicators such as Glasgow Coma Scale, heart rate, mean arterial pressure, lactic acid, hemoglobin, urine output, as well as APACHE II and SAPS II scales, were recorded on the day of admission to the ICU.Data analysis: Data were analyzed using multiple logistic regression and Mann-Whitney Test. Multiple logistic regression analysis was performed to examine the predictive capacity of specific indicators on patient outcome.Results: The results of the analysis showed that in cases where all clinical indicators changed, then patient outcome may be affected by 79,4% (Relative Risk 3.846, p<0.001). Glasgow Coma Scale (p=0.022) and hemoglobin (p=0.013) were the strongest influencing factors related to patient outcome. Mann-Whitney analysis was used to evaluate the predictive value of Apache II and SAPS II and demonstrated that both systems could significantly predict patient outcome (APACHE II=0.019 and SAPS II=0.013).Conclusion: Hemoglobin and Glasgow Coma Scale values upon multi-trauma patient admission to the ICU appear to be strong prognostic factors of patient outcome.

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ACUTE METHANOL POISENING: PROGNOSTIC FACTORS AND ROLE OF GLASGOW COMA SCALE

The Egyptian Journal of Forensic Sciences and Applied Toxicology ◽

10.21608/ejfsat.2018.5981.1030 ◽

2018 ◽

Vol 18 (4) ◽

pp. 47-57

Author(s):

Ghada Mansour ◽

Mohamed AGLAN ◽

mahmoud Abd Elwahab

Keyword(s):

Prognostic Factors ◽

Glasgow Coma Scale ◽

Coma Scale

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Mortality by Decade in Trauma Patients with Glasgow Coma Scale 3

The American Surgeon ◽

10.1177/000313481107701015 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1342-1345 ◽

Cited By ~ 3

Author(s):

Eric J. Ley ◽

Morgan A. Clond ◽

Omar N. Hussain ◽

Marissa Srour ◽

James Mirocha ◽

...

Keyword(s):

Los Angeles ◽

Glasgow Coma Scale ◽

Trauma System ◽

Mortality Rates ◽

High Survival ◽

Trauma Patients ◽

Coma Scale ◽

The Third ◽

Aggressive Care ◽

Improvement In Survival

The aim of this study was to assess how increasing age affects mortality in trauma patients with Glasgow Coma Scale (GCS) 3. The Los Angeles County Trauma System Database was queried for all patients aged 20 to 99 years admitted with GCS 3. Mortality was 41.8 per cent for the 3306 GCS 3 patients. Mortality in the youngest patients reviewed, those in the third decade, was 43.5 per cent. After logistic regression analysis, patients in the third decade had similar mortality rates to patients in the sixth (adjusted OR, 0.88; CI, 0.68 to 1.14; P = 0.33) and seventh decades (adjusted OR, 0.96; CI, 0.70 to 1.31; P = 0.79). A significantly lower mortality rate, however, was noted in the fifth decade (adjusted OR, 0.76; CI, 0.61 to 0.95; P = 0.02). Conversely, significantly higher mortality rates were noted in the eighth (adjusted OR, 1.93; CI, 1.38 to 2.71; P = 0.0001) and combined ninth/tenth decades (adjusted OR, 2.47; CI, 1.71 to 3.57; P < 0.0001). Given the high survival in trauma patients with GCS 3 as well as continued improvement in survival compared with historical controls, aggressive care is indicated for patients who present to the emergency department with GCS 3.

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Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

Journal of Neurosurgery ◽

10.3171/2017.12.jns172780 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1612-1620 ◽

Cited By ~ 27

Author(s):

Paul M. Brennan ◽

Gordon D. Murray ◽

Graham M. Teasdale

Keyword(s):

Patient Outcome ◽

Mortality Rate ◽

Glasgow Coma Scale ◽

Brain Damage ◽

Unfavorable Outcome ◽

Simple Arithmetic ◽

Coma Scale ◽

Pupil Response ◽

Gcs Score ◽

Complex Methods

OBJECTIVEGlasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this.METHODSInformation about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis.Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3–15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1–15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke’s R2.RESULTSSeparately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P.CONCLUSIONSA simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.

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