scholarly journals Traumatic Brain Injury: Prognostic Value of Various Coma Scales, CT Scores & Their Comparison Based on Clinical Outcome

2021 ◽  
Vol 6 (3) ◽  
pp. 26-30
Author(s):  
Ashrit Reddy Cheruku ◽  
Suryanarayan Reddy V
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Group Iv ◽  
Coma Scale ◽  
Group I ◽  
Highly Sensitive ◽  
Four Score ◽  
Group Ii ◽  
Gcs Score

Background: Traumatic brain injury (TBI) is common, carries a high morbidity and mortality and has no specific treatment. The Glasgow coma scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury against which other scale are compared to overcome the disadvantages of GCS. Materials & Methods: This is Prospective Observational comparative study was conducted in total 128 who admitted with traumatic brain injury (TBI) in Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during the period from November 2016 to November 2018. Results: A total of 128 (112 males) patients were included in the study. Among SMS, 0 is highly sensitive (72.22%), 2 is highly specific (80.43%). In GCS score < 8 was highly sensitive (97.22%) & GCS score 9 - 12 was highly specific (82.61%). In this study Marshall CT score of 4 - 6 (group II) has mortality 43.55% & CT score 1 - 3 (group I) was 13.64%. Where as in Rotterdam CT score was significant mortality with score 4 - 6 (group II) was 56.25% & CT score of 1 - 3 (group I) was 24.11%. In FOUR score with GCS, on 1 day with FOUR score 13 - 16 (group IV) has 5.56%, day 3, 13 - 16 (group IV) has 3.45%, day 7, 13 - 16 (group IV) has 3.13% & day 21, 13 - 16 (group IV) only 3.45% has mortality rate. Conclusion: if SMS is high there is more chance of survival, this helps in patients immediate segregation of patients in casualty. Also conclude that FOUR score has a high degree of internal consistency & is an accurate predictor of Mortality and neurologic outcome in TBI patients. Keywords: Simplified Motor Score, Glasgow Coma Scale, Marshall CT, Rotterdam CT, FOUR scale.

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

scholarly journals Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury

2015 ◽  
Vol 10 (2) ◽  
pp. 4-9
Author(s):  
SK Sah ◽  
ND Subedi ◽  
K Poudel ◽  
M Mallik
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Midline Shift ◽  
Female Ratio ◽  
Coma Scale ◽  
Acute Traumatic Brain Injury ◽  
Gcs Score

OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury attending in Chitwan Medical College teaching hospital Chitwan, Nepal.MATERIALS AND METHODS A cross-sectional study was performed among 50 patients of acute (less than24 hours) cases of craniocerebral trauma over a period of four months. The patient’s level of consciousness (GCS) was determined and a brain CT scan without contrast media was performed. A sixth generation General Electric (GE) CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.RESULT The age range of the patients was 1 to 75 years (mean age 35.6± 21.516 years) and male: female ratio was 3.1:1. The most common causes of head injury were road traffic accident (RTA) (60%), fall injury (20%), physical assault (12%) and pedestrian injuries (8%). The distribution of patients in accordance with consciousness level was found to be 54% with mild TBI (GCS score 12 to 14), 28% with moderate TBI (GCS score 11 to 8) and 18% with severe TBI (GCS score less than 7). The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan was accompanied by lower GCS.CONCLUSION The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan were accompanied with lower GCS. Patients having single lesion had more GCS level than mixed level and mid line shift type of injury.Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 4-9

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 Glasgow Coma Scale versus Full Outline of Unresponsiveness Scale in Predicting Discharge Outcomes of Traumatic Brain Injury

2019 ◽  
Vol 1 (4) ◽  
pp. 9
Author(s):  
Eman B. Kasem ◽  
Sahar Y. Mohammad ◽  
Dalia A. Amin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Essential Element ◽  
University Hospital ◽  
Discharge Data ◽  
Coma Scale ◽  
Discharge Outcomes ◽  
Valid Predictor ◽  
Four Score

Context: Neurological assessment is an essential element of early warning scores used to recognize and early save the lives of critically ill patients.Aim: This study aimed to compare the full outline of Unresponsiveness Scale and the Glasgow Coma Scale in predicting discharge outcomes in patients with traumatic brain injuryMethod: A comparative research design conducted at Neurosurgery Intensive Care Unit in El Fayoum University Hospital. The Study recruited a purposive sample of 100 adult patients with TBI. They assessed using three tools (Patients Profile Data Form, Level of Consciousness Assessment," and Tool Discharge Data Assessment Record).Results: GCS is superior to FOUR score in prediction of length of stay and full recovery without any squeal while they are the same in the prediction of motor disability and sensory impairment (physical impairment). FOUR score is superior to GCS in the prediction of mortalityConclusion: the FOUR score provides more neurologic details than the GCS and is a valid predictor of outcome in patients with TBI; thus, it could be considered as a future prognostic model. It recommended for using FOUR score for predicting outcomes in patients with traumatic brain injuries as a valid predictor of discharge outcomes after traumatic brain injury.

Regional cerebrovascular responses to progressive hypotension after traumatic brain injury in cats

1992 ◽  
Vol 263 (4) ◽  
pp. H1276-H1284 ◽  
Author(s):  
D. S. DeWitt ◽  
D. S. Prough ◽  
C. L. Taylor ◽  
J. M. Whitley ◽  
D. D. Deal ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Regions ◽  
Group Iv ◽  
Group Iii ◽  
Hemorrhagic Hypotension ◽  
Isoflurane Anesthesia ◽  
Group I ◽  
Injury Group ◽  
Group Ii

We investigated the effects of hypotension on cerebral blood flow (CBF) after traumatic brain injury (TBI) in cats. Isoflurane-anesthetized cats were prepared for TBI and for microsphere measurements of total (T) and regional (r) CBF. Four groups were studied: sham injury (group I, n = 6); TBI (group II, n = 6); isoflurane anesthesia, no TBI or hypotension (group III, n = 4); and isoflurane and TBI, no hypotension (group IV, n = 8). After TBI or sham trauma, mean arterial pressure (MAP) was reduced to 80, 60, and 40 mmHg by hemorrhage. Group I TCBF did not change significantly from baseline until MAP reached 40 mmHg, but rCBF was more dependent on MAP in anterior hemispheric than in brain stem regions. Group II TCBF was significantly lower than baseline, and group I TCBF at all levels of hypotension and autoregulation was impaired at higher MAP levels in anterior than in posterior brain regions. Groups III and IV indicated that decreases in TCBF were not due to duration of the preparation or to TBI in the absence of hemorrhagic hypotension. We conclude that global and regional autoregulation are absent in response to hemorrhagic hypotension after TBI.

scholarly journals Coma scales: a historical review

2010 ◽  
Vol 68 (6) ◽  
pp. 930-937 ◽  
Author(s):  
Ana Luisa Bordini ◽  
Thiago F. Luiz ◽  
Maurício Fernandes ◽  
Walter O. Arruda ◽  
Hélio A.G. Teive
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Predictive Value ◽  
Historical Review ◽  
Medical Community ◽  
Review Of The Literature ◽  
Chronological Order ◽  
Coma Scale ◽  
Four Score

OBJECTIVE: To describe the most important coma scales developed in the last fifty years. METHOD: A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. RESULTS: Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. DISCUSSION: Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

scholarly journals CAN FULL OUTLINE OF UNRESPONSIVENESS SCORE (FOUR) REPLACE GLASGOW COMA SCALE (GCS) IN HEAD INJURY?: VALIDATION AT TERITIARY CARE CENTRE IN NEPAL

2018 ◽  
Vol 6 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Prakash Kafle ◽  
Mohan Raj Sharma ◽  
Sushil K Shilpakar ◽  
Gopal Sedain ◽  
Amit Pradhanang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Outcome Measurement ◽  
University Teaching ◽  
Predictive Values ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Four Score

Introduction : Traumatic brain injury (TBI) is one of the major cause of severe disability and death world wide.The mortality rate in these patients largely depends on initial severity of trauma. In TBI, initial level of consciousness is most important prognostic indicator. The commonest scale is the Glasgow Coma Scale (GCS). Despite its widespread use, the GCS has some significant limitations, including variations in inter rater reliability and predictive validity. In order to overcome deficiencies of the GCS, an alternative scale called FOUR (Full Outline of Unresponsiveness score) has been developed and validated in several neurosurgical centers in North America. This study was an attempt to validate this score in Nepalese Setting.  This study was carried out in the Department of Neurosurgery at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The main objective ofthe study was to compare the FOUR with GCS in predicting outcome in patients with Traumatic brain injury.MATERIAL AND METHODS: Patients with moderate to severe head injury aged 2: 16 years admitted in the Department ofNeurosurgery were eligible to participate in the study.The GCS and FOUR score were measured at the earliest possible time during admission by the single observer. Glasgow Outcome Scale (GOS) was measured at discharge and at 3 months follow up. Mortality was used as the primary outcome measure.RESULTS: Total  of 122 patients were included in the study. The mean age of the study population was 38.7 ± 18 years. Mean GCS score among survivors was higher than that among non-survivors which was statistically significant (10.9 ± 2 vs. 6 ± 1.12 (p <0.001). Similarly mean FOUR score among survivors was significantly higher than that among non-survivors ( 12. 8±2.49 vs. 6.08 ± 1.72 (p< 0.001). The cut off point for GCS and FOUR score were ≤ 7and ≤ 8 respectively. The area under ROC curve for GCS for prediction of mortality was 0.975 (95% CI; 0.947-1.000; p<0.001) and for FOUR score was 0.981 (95% CI; 0.960-1.000; p<0.001) suggesting good discrimination ability ofboth models.The overall sensitivity, specificity, positive predictive value and negative predictive values of GCS were 91.67%, 91.82%, 55% and 99% respectively while that for FOUR score were 100%, 91.82%, 57.1 % and 100%respectively.CONCLUSION: The outcome measurement of FOUR score was comparable with the GCS in traumatic brain injury and both the scores correlated well.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 32-39 

scholarly journals Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

2014 ◽  
Vol 41 (4) ◽  
pp. 256-262 ◽  
Author(s):  
Nelson Saade ◽  
José Carlos Esteves Veiga ◽  
Luiz Fernando Cannoni ◽  
Luciano Haddad ◽  
João Luiz Vitorino Araújo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Csf Leak ◽  
Pupillary Reflex ◽  
Coma Scale ◽  
Intracranial Lesions ◽  
Gcs Score

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.

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