scholarly journals The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data

2018 ◽  
Vol 15 (11) ◽  
pp. 2346 ◽  
Author(s):  
Shao-Chun Wu ◽  
Cheng-Shyuan Rau ◽  
Spencer Kuo ◽  
Peng-Chen Chien ◽  
Hsiao-Yun Hsieh ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Predictive Accuracy ◽  
Trauma Patients ◽  
Shock Index ◽  
Reverse Shock ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Gcs Score

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

scholarly journals Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chu Wan-Ting ◽  
Liao Chin-Hsien ◽  
Lin Cheng-Yu ◽  
Chien Cheng-Yu ◽  
Lin Chi-Chun ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Shock Index ◽  
Reverse Shock ◽  
Coma Scale

Improved Identification of Severely Injured Pediatric Trauma Patients Using Reverse Shock Index Multiplied by Glasgow Coma Scale (rSIG)

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marina L. Reppucci ◽  
Shannon N. Acker ◽  
Emily Cooper ◽  
Maxene Meier ◽  
Jenny Stevens ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Shock Index ◽  
Reverse Shock ◽  
Coma Scale

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

scholarly journals Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury

2021 ◽  
Vol 8 (12) ◽  
pp. 3583
Author(s):  
Fahad Ansari ◽  
Arvind Rai
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Youden Index ◽  
Traumatic Head Injury ◽  
Coma Scale ◽  
Medical College ◽  
Traumatic Head ◽  
Four Score ◽  
Gandhi Medical College ◽  
Gcs Score

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients. 

Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

2020 ◽  
Vol 37 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Amit Kochar ◽  
Meredith L Borland ◽  
Natalie Phillips ◽  
Sarah Dalton ◽  
John Alexander Cheek ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decision Rules ◽  
Secondary Analysis ◽  
Clinical Decision ◽  
Important Indicator ◽  
Coma Scale ◽  
Gcs Score

ObjectiveHead injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.MethodsPlanned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.ResultsOf 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).ConclusionsOutside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.

scholarly journals Correlation of Glasgow Coma Scale with Non-Contrast Computed Tomography findings in immediate post traumatic brain injury

2019 ◽  
Vol 7 (4) ◽  
pp. 1059
Author(s):  
Basudev Agrawal ◽  
Rupesh Verma
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Age Group ◽  
Female Ratio ◽  
Coma Scale ◽  
Gcs Score

Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.

scholarly journals HUBUNGAN SKOR GLASGOW COMA SCALE (GCS) DENGAN JUMLAH TROMBOSIT PADA PASIEN CEDERA KEPALA DI IGD RSUD ULIN BANJARMASIN

2016 ◽  
Vol 12 (2) ◽  
pp. 289
Author(s):  
Annisa Yutami ◽  
Kenanga Marwan Sikumbang ◽  
Asnawati Asnawati
Keyword(s):  
Emergency Department ◽  
Platelet Count ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
General Hospital ◽  
Severe Head Injury ◽  
Cross Sectional ◽  
Coma Scale ◽  
Consumptive Coagulopathy ◽  
Gcs Score

Abstract: Head injuries are a public health and a serious socio-economic problems in the world. Head injury classified quantitatively using the Glasgow Coma Scale (GCS) score. Consumptive coagulopathy that often arises in patients with head injury associated with a tenfold adjusted risk of death. Consumptive coagulopathy marked by a decrease in the number of platelets. The purpose of the study was to analyze the relationship between GCS score with total platelet count in head injury patients at Emergency Department Ulin General Hospital Banjarmasin. This study was an observational analytic cross sectional study. Seventy three samples were obtained according to the inclusions criteria with 28 mild head injury patients, 26 moderate head injury patients, and 19 severe head injury patients. Seven patients had thrombocytopenia, from moderate head injury and severe head injury groups. From statistical test using one way ANOVA with confidence level of 95% was obtained p=0.402. It can be concluded that there is no relationship between GCS score with total platelet count in head injury patients at Emergency Department Ulin General Hospital. Keywords: head injury, GCS, platelet count Abstrak: Cedera kepala merupakan masalah kesehatan masyarakat dan sosial ekonomi yang serius di dunia. Cedera kepala diklasifikasikan secara kuantitatif menggunakan skor Glasgow Coma Scale (GCS). Koagulopati konsumtif yang sering muncul pada pasien cedera kepala dapat meningkatkan risiko kematian menjadi sepuluh kali lipat. Koagulopati konsumtif ditandai dengan penurunan jumlah trombosit. Tujuan penelitian untuk mengetahui apakah terdapat hubungan antara skor GCS dengan jumlah trombosit pada pasien cedera kepala di IGD RSUD Ulin Banjarmasin. Penelitian ini bersifat observasional analitik cross sectional. Didapatkan 73 sampel yang sesuai dengan kriteria inklusi, dengan perincian 28 pasien cedera kepala ringan (CKR), 26 pasien cedera kepala sedang (CKS), dan 19 pasien cedera kepala berat (CKB). Tujuh pasien mengalami trombositopenia, dari kelompok pasien cedera kepala sedang dan cedera kepala berat. Dari uji statistik  menggunakanone-way ANOVA dengan tingkat kepercayaan 95% didapatkan nilai p=0,402. Dapat disimpulkan bahwa tidak terdapat hubungan antara skor GCS dengan jumlah trombosit pada pasien cedera kepala di IGD RSUD Ulin Banjarmasin. Kata-kata Kunci: cedera kepala, GCS, jumlah trombosit

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