Early Glasgow Coma Scale Score and Prediction of Traumatic Brain Injury: A Secondary Analysis of Three Harmonized Prehospital Randomized Clinical Trials

被引:1
作者
Iyanna, Nidhi [1 ]
Donohue, Jack K. [1 ]
Lorence, John M. [1 ]
Guyette, Francis X. [2 ]
Gimbel, Elizabeth [3 ]
Brown, Joshua B. [1 ]
Daley, Brian J. [4 ]
Eastridge, Brian J. [5 ]
Miller, Richard S. [6 ]
Nirula, Raminder [7 ]
Harbrecht, Brian G. [8 ]
Claridge, Jeffrey A. [9 ]
Phelan, Herb A. [10 ]
Vercruysse, Gary A. [11 ]
O'Keefe, Terence [11 ]
Joseph, Bellal [11 ]
Shutter, Lori A. [3 ]
Sperry, Jason L. [1 ]
机构
[1] Univ Pittsburgh, Dept Surg, Div Trauma & Gen Surg, Pittsburgh, PA 15260 USA
[2] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA USA
[3] Univ Pittsburgh, Dept Crit Care Med, Pittsburgh, PA USA
[4] Univ Tennessee, Hlth Sci Ctr, Dept Surg, Knoxville, TN USA
[5] Univ Texas Hlth San Antonio, Dept Surg, San Antonio, TX USA
[6] JPS Hlth Network, Dept Surg, Ft Worth, TX USA
[7] Univ Utah, Dept Surg, Salt Lake City, UT USA
[8] Univ Louisville, Dept Surg, Louisville, KY USA
[9] Case Western Reserve Univ, Metro Hlth Med Ctr, Dept Surg, Cleveland, OH USA
[10] Univ Texas Southwestern, Dept Surg, Dallas, TX USA
[11] Univ Arizona, Dept Surg, Tucson, AZ USA
关键词
O WHOLE-BLOOD; PLASMA; MORTALITY; UTILITY; GFAP;
D O I
10.1080/10903127.2024.2381048
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
ObjectivesThe prehospital prediction of the radiographic diagnosis of traumatic brain injury (TBI) in hemorrhagic shock patients has the potential to promote early therapeutic interventions. However, the identification of TBI is often challenging and prehospital tools remain limited. While the Glasgow Coma Scale (GCS) score is frequently used to assess the extent of impaired consciousness after injury, the utility of the GCS scores in the early prehospital phase of care to predict TBI in patients with severe injury and concomitant shock is poorly understood.MethodsWe performed a post-hoc, secondary analysis utilizing data derived from three randomized prehospital clinical trials: the Prehospital Air Medical Plasma trial (PAMPER), the Study of Tranexamic Acid During Air Medical and Ground Prehospital Transport trial (STAAMP), and the Pragmatic Prehospital Type O Whole Blood Early Resuscitation (PPOWER) trial. Patients were dichotomized into two cohorts based on the presence of TBI and then further stratified into three groups based on prehospital GCS score: GCS 3, GCS 4-12, and GCS 13-15. The association between prehospital GCS score and clinical documentation of TBI was assessed.ResultsA total of 1,490 enrolled patients were included in this analysis. The percentage of patients with documented TBI in those with a GCS 3 was 59.5, 42.4% in those with a GCS 4-12, and 11.8% in those with a GCS 13-15. The positive predictive value (PPV) of the prehospital GCS score for the diagnosis of TBI is low, with a GCS of 3 having only a 60% PPV. Hypotension and prehospital intubation are independent predictors of a low prehospital GCS. Decreasing prehospital GCS is strongly associated with higher incidence or mortality over time, irrespective of the diagnosis of TBI.ConclusionsThe ability to accurately predict the presence of TBI in the prehospital phase of care is essential. The utility of the GCS scores in the early prehospital phase of care to predict TBI in patients with severe injury and concomitant shock is limited. The use of novel scoring systems and improved technology are needed to promote the accurate early diagnosis of TBI.
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页数:9
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