FOUR Score Versus GCS in Patients with Traumatic Brain Injury in the Prehospital Setting

FOUR score versus GCS in patients with traumatic brain injury in the prehospital setting

10.21203/rs.3.rs-18036/v3 ◽

2020 ◽

Author(s):

Matej Rubelli Furman ◽

Mario Gorenjak ◽

Janez Ravnik

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Roc Curve ◽

Prehospital Setting ◽

Youden Index ◽

Correct Prediction ◽

Severity Scores ◽

Predicting Outcome ◽

Four Score ◽

Sensitivity Specificity

Abstract Background: In the last few decades, different coma scoring scales have been proposed. The purpose of this study is to compare two coma scales:, the GCS (Glasgow Coma Scale) and the FOUR score (Full Outline of UnResponsiveness score), aiming to examine which scale is better for predicting outcome in traumatic brain injury (TBI) patients in the prehospital setting.Methods: We evaluated the GCS and FOUR scores in the prehospital setting at three different prehospital timepoints, and we reassessed the scores in surviving patients 24 hours, one month and three months after the injury. Then, we compared the outcomes.We used the χ² method, and based on the analysis with the best cut-off point for each model, we calculated the sensitivity, specificity and correct prediction of outcomes with four severity scores. The Youden index, Z score, McNemar's test and ROC curve were also assessed. P < 0.05 was considered statistically significant. Both scales were ranked with gain ratios.Results: We included 200 TBI patients who were treated in a prehospital setting by a prehospital specialized medical unit. In terms of the predictions of positive outcomes, our study showed the following:1. Twenty-four hours after the injury, the best cut-off points obtained were from the FOUR 1 and GCS 1 models.2. One month after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 3 as well as FOUR 3 and GCS 3.3. Three months after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 1, FOUR 3 and GCS 1, and GCS 1 and GCS 2.Conclusions: In our study, the results of our research confirm that there are no practical or clinical differences between the GCS and FOUR scores in terms of predicting morality outcomes 24 hours, one month, and three months after injury. No statistically significant differences were found in the Youden index or the area under the ROC curve 24 hours, one month or three months after the injury.

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FOUR score versus GCS in patients with traumatic brain injury in the prehospital setting

10.21203/rs.3.rs-18036/v2 ◽

2020 ◽

Author(s):

Matej Rubelli Furman ◽

Mario Gorenjak ◽

Janez Ravnik

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Roc Curve ◽

Prehospital Setting ◽

Youden Index ◽

Correct Prediction ◽

Severity Scores ◽

Predicting Outcome ◽

Four Score ◽

Sensitivity Specificity

Abstract Background: In the last few decades, different coma scoring scales have been proposed. The purpose of this study is to compare two coma scales: the GCS (Glasgow Coma Scale) and the FOUR score (Full Outline of UnResponsiveness score), aiming to examine which scale is better for predicting outcome in traumatic brain injury (TBI) patients in the prehospital setting.Methods: We evaluated the GCS and FOUR scores in the prehospital setting at three different prehospital timepoints, and we reassessed the scores in surviving patients 24 hours, one month and three months after the injury. Then, we compared the outcomes.We used the χ² method, and based on the analysis with the best cut-off point for each model, we calculated the sensitivity, specificity and correct prediction of outcomes with four severity scores. The Youden index, Z score, McNemar's test and ROC curve were also assessed. P < 0.05 was considered statistically significant. Both scales were ranked with gain ratios.Results: We included 200 TBI patients who were treated in a prehospital setting by a prehospital specialized medical unit. In terms of the predictions of positive outcomes, our study showed the following:1. Twenty-four hours after the injury, the best cut-off points obtained were from the FOUR 1 and GCS 1 models.2. One month after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 3 as well as FOUR 3 and GCS 3.3. Three months after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 1, FOUR 3 and GCS 1, and GCS 1 and GCS 2.Conclusions: In our study, the results of our research confirm that there are no practical or clinical differences between the GCS and FOUR scores in terms of predicting morality outcomes 24 hours, one month, and three months after injury. No statistically significant differences were found in the Youden index or the area under the ROC curve 24 hours, one month or three months after the injury.

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FOUR score versus GCS in patients with traumatic brain injury in the prehospital setting

10.21203/rs.3.rs-18036/v4 ◽

2020 ◽

Author(s):

Matej Rubelli Furman ◽

Mario Gorenjak ◽

Janez Ravnik

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Roc Curve ◽

Prehospital Setting ◽

Youden Index ◽

Correct Prediction ◽

Severity Scores ◽

Predicting Outcome ◽

Four Score ◽

Sensitivity Specificity

Abstract Background: In the last few decades, different coma scoring scales have been proposed. The purpose of this study is to compare two coma scales, the GCS (Glasgow Coma Scale) and the FOUR score (Full Outline of UnResponsiveness score), aiming to examine which scale is better for predicting outcome in traumatic brain injury (TBI) patients in the prehospital setting.Methods: We evaluated the GCS and FOUR scores in the prehospital setting at three different prehospital timepoints, and we reassessed the scores in surviving patients 24 hours, one month and three months after the injury. Then, we compared the outcomes.We used the χ² method, and based on the analysis with the best cut-off point for each model, we calculated the sensitivity, specificity and correct prediction of outcomes with four severity scores. The Youden index, Z score, McNemar's test and ROC curve were also assessed. P < 0.05 was considered statistically significant. Both scales were ranked with gain ratios.Results: We included 200 TBI patients who were treated in a prehospital setting by a prehospital specialized medical unit. In terms of the predictions of positive outcomes, our study showed the following:1. Twenty-four hours after the injury, the best cut-off points obtained were from the FOUR 1 and GCS 1 models.2. One month after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 3 as well as FOUR 3 and GCS 3.3. Three months after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 1, FOUR 3 and GCS 1, and GCS 1 and GCS 2.Conclusions: In our study, the results of our research confirm that there are no practical or clinical differences between the GCS and FOUR scores in terms of predicting morality outcomes 24 hours, one month, and three months after injury. No statistically significant differences were found in the Youden index or the area under the ROC curve 24 hours, one month or three months after the injury.

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FOUR score versus GCS in patients with traumatic brain injury in the prehospital setting

10.21203/rs.3.rs-18036/v5 ◽

2021 ◽

Author(s):

Matej Rubelli Furman ◽

Mario Gorenjak ◽

Janez Ravnik

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Roc Curve ◽

Prehospital Setting ◽

Youden Index ◽

Correct Prediction ◽

Severity Scores ◽

Predicting Outcome ◽

Four Score ◽

Sensitivity Specificity

Abstract Background: In the last few decades, different coma scoring scales have been proposed. The purpose of this study is to compare two coma scales, the GCS (Glasgow Coma Scale) and the FOUR score (Full Outline of UnResponsiveness score), aiming to examine which scale is better for predicting outcome in traumatic brain injury (TBI) patients in the prehospital setting.Methods: We evaluated the GCS and FOUR scores in the prehospital setting at three different prehospital timepoints, and we reassessed the scores in surviving patients 24 hours, one month and three months after the injury. Then, we compared the outcomes.We used the χ² method, and based on the analysis with the best cut-off point for each model, we calculated the sensitivity, specificity and correct prediction of outcomes with four severity scores. The Youden index, Z score, McNemar's test and ROC curve were also assessed. P < 0.05 was considered statistically significant. Both scales were ranked with gain ratios.Results: We included 200 TBI patients who were treated in a prehospital setting by a prehospital specialized medical unit. In terms of the predictions of positive outcomes, our study showed the following:1. Twenty-four hours after the injury, the best cut-off points obtained were from the FOUR 1 and GCS 1 models.2. One month after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 3 as well as FOUR 3 and GCS 3.3. Three months after the injury, the best cut-off points obtained were from the following models: FOUR 2 and GCS 1, FOUR 3 and GCS 1, and GCS 1 and GCS 2.Conclusions: In our study, the results of our research confirm that there are no practical or clinical differences between the GCS and FOUR scores in terms of predicting morality outcomes 24 hours, one month, and three months after injury. No statistically significant differences were found in the Youden index or the area under the ROC curve 24 hours, one month or three months after the injury.

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FOUR score versus GCS in patients with traumatic brain injury in the prehospital setting

10.21203/rs.3.rs-18036/v1 ◽

2020 ◽

Author(s):

Matej Rubelli Furman ◽

Mario Gorenjak ◽

Janez Ravnik

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Roc Curve ◽

Prehospital Setting ◽

Youden Index ◽

Correct Prediction ◽

Prediction Of Mortality ◽

Severity Scores ◽

Mortality Outcome ◽

Four Score

Abstract Background: In the last few decades, different coma scoring scales have been proposed. The purpose of this study is to compare two coma scales: the GCS (Glasgow Coma Scale) and the FOUR score (Full Outline of UnResponsiveness score), aiming to examine which scale is better in predicting mortality outcome in traumatic brain injury (TBI) patients in the prehospital setting. Methods: We evaluated the GCS and FOUR score in the prehospital setting at three different prehospital timepoints, and we reassessed the scores in surviving patients 24 hours, one month and three months after the injury. Then, we compared the mortality outcomes. We used the χ² method with the best cut-off point for each model; we calculated sensitivity, specificity and correct prediction of the outcome with four severity scores. The Youden index, Z score, McNemar's test and ROC curve were also assessed. P < 0.05 was considered statistically significant. Both scales were ranked with gain ratio. Results: We included 75 TBI patients who were treated in a prehospital setting by a prehospital specialized medical unit. In terms of predictions of mortality, our study showed the following: 1. Twenty-four hours after the injury, the best cut-off points obtained were from the FOUR 2 and FOUR 3 models. 2. One month after the injury, the best cut-off obtained was from the GCS 2 model. 3. Three months after the injury, the best cut-offs obtained were from the GCS 2 and GCS 3 models. Conclusions: In our study, we were able to demonstrate that the FOUR 2 and FOUR 3 models, compared to the GCS 2 and GCS 3 models, resulted in only a marginally better prediction of mortality outcome 24 hours after TBI. Statistically significant differences were found in neither the Youden index nor the area under the ROC curve after 24 hours and one and three months after the injury.

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Faculty Opinions recommendation of Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1102029.557997 ◽

2008 ◽

Author(s):

Olaf L Cremer

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Large Cohort ◽

Prognostic Models ◽

Predicting Outcome

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GCS-Pupil Score Has a Stronger Association with Mortality and Poor Functional Outcome than GCS Alone in Pediatric Severe Traumatic Brain Injury

Pediatric Neurosurgery ◽

10.1159/000517330 ◽

2021 ◽

pp. 1-8

Author(s):

Binod Balakrishnan ◽

Heather VanDongen-Trimmer ◽

Irene Kim ◽

Sheila J. Hanson ◽

Liyun Zhang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Cerebral Performance Category ◽

Regression Tree ◽

Classification And Regression Tree ◽

Continuous Variables ◽

Poor Functional Outcome ◽

Severity Scores ◽

Pupil Reactivity

Background: The Glasgow Coma Scale (GCS), used to classify the severity of traumatic brain injury (TBI), is associated with mortality and functional outcomes. However, GCS can be affected by sedation and neuromuscular blockade. GCS-Pupil (GCS-P) score, calculated as GCS minus Pupil Reactivity Score (PRS), was shown to better predict outcomes in a retrospective cohort of adult TBI patients. We evaluated the applicability of GCS-P to a large retrospective pediatric severe TBI (sTBI) cohort. Methods: Admissions to pediatric intensive care units in the Virtual Pediatric Systems (VPS, LLC) database from 2010 to 2015 with sTBI were included. We collected GCS, PRS (number of nonreactive pupils), cardiac arrest, abusive head trauma status, illness severity scores, pediatric cerebral performance category (PCPC) score, and mortality. GCS-P was calculated as GCS minus PRS. χ2 or Fisher’s exact test and Mann-Whitney U test compared categorical and continuous variables, respectively. Classification and regression tree analysis identified thresholds of GCS-P and GCS along with other independent factors which were further examined using multivariable regression analysis to identify factors independently associated with mortality and unfavorable PCPC at PICU discharge. Results: Among the 2,682 patients included in the study, mortality was 23%, increasing from 4.7% for PRS = 0 to 80% for PRS = 2. GCS-P identified more severely injured patients with GCS-P scores 1 and 2 who had worse outcomes. GCS-P ≤ 2 had higher odds for mortality, OR = 68.4 (95% CI = 50.6–92.4) and unfavorable PCPC, OR = 17.3 (8.1, 37.0) compared to GCS ≤ 5. GCS-P ≤ 2 also had higher specificity and positive predictive value for both mortality and unfavorable PCPC compared to GCS ≤ 5. Conclusions: GCS-P, by incorporating pupil reactivity to GCS scoring, is more strongly associated with mortality and poor functional outcome at PICU discharge in children with sTBI.

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Novel severe traumatic brain injury blood outcome biomarkers identified with proximity extension assay

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0103 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Douglas D. Fraser ◽

Michelle Chen ◽

Annie Ren ◽

Michael R. Miller ◽

Claudio Martin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Roc Curve ◽

Vascular Pathology ◽

Targeted Proteomics ◽

Control Subjects ◽

Matched Healthy Control ◽

Healthy Control ◽

Age And Sex

Abstract Objectives Severe traumatic brain injury (sTBI) patients suffer high mortality. Accurate prognostic biomarkers have not been identified. In this exploratory study, we performed targeted proteomics on plasma obtained from sTBI patients to identify potential outcome biomarkers. Methods Blood sample was collected from patients admitted to the ICU suffering a sTBI, using standardized clinical and computerized tomography (CT) imaging criteria. Age- and sex-matched healthy control subjects and sTBI patients were enrolled. Targeted proteomics was performed on plasma with proximity extension assays (1,161 proteins). Results Cohorts were well-balanced for age and sex. The majority of sTBI patients were injured in motor vehicle collisions and the most frequent head CT finding was subarachnoid hemorrhage. Mortality rate for sTBI patients was 40%. Feature selection identified the top performing 15 proteins for identifying sTBI patients from healthy control subjects with a classification accuracy of 100%. The sTBI proteome was dominated by markers of vascular pathology, immunity/inflammation, cell survival and macrophage/microglia activation. Receiver operating characteristic (ROC) curve analyses demonstrated areas-under-the-curves (AUC) for identifying sTBI that ranged from 0.870-1.000 (p≤0.005). When mortality was used as outcome, ROC curve analyses identified the top 3 proteins as vWF, WIF-1, and CSF-1. Combining vWF with either WIF-1 or CSF-1 resulted in excellent mortality prediction with AUC of 1.000 for both combinations (p=0.011). Conclusions Targeted proteomics with feature classification and selection distinguished sTBI patients from matched healthy control subjects. Two protein combinations were identified that accurately predicted sTBI patient mortality. Our exploratory findings require confirmation in larger sTBI patient populations.

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