Article

OBJECTIVE: To examine possible changes in Glasgow Coma Scale (GCS) scores related
to changes in emergency management, such as intubation and chemical paralysis,
and the potential impact on outcome prediction. PARTICIPANTS: 10 228 patients
from the Traumatic Brain Injury Model Systems national database. DESIGN:
Retrospective study examining 5-year epochs from 1987 to 2012. MAIN MEASURES: GCS
score assessed in the Emergency Department (GCS scores for intubated, but not
paralyzed, patients were estimated with a formula using 2 of the 3 GCS
components), Outcome: Functional Independence Measure (FIM) assessed at
rehabilitation admission. RESULTS: The rate of intubation prior to GCS scoring
averaged 43% and did not increase across time. However, a clear increase over
time was observed in the use of paralytics or heavy sedatives, with 27% of
patients receiving this intervention in the most recent epoch. Estimated GCS
scores classified 69% of intubated patients as severely brain injured and 8% as
mildly injured. The GCS accounted for a modest, yet consistent, amount of
variability (approximately 5%-7%) in FIM scores during most epochs. CONCLUSIONS:
Given the frequency of intubation and/or paralysis following brain injury in this
sample, estimating GCS or exploring other means to gauge injury severity is
beneficial, particularly because a portion likely did not sustain severe brain injury. There is no evidence for declining predictive utility of the GCS over time.
- Echelle de Glasgow

Langue : ANGLAIS