Critique of the Glasgow Coma Scale (GCS)

Kashani, Ehsan; Ziarat, Hadiseh Monadi; Tajabadi, Ali

doi:10.5812/ccn.90156

Cited by 1 publication

(1 citation statement)

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“…However, both modules are highly relevant for early sepsis detection, which is reflected by the modified use in the quick SOFA score, among others [ 3 ]. Although the trained intensivist was aware of the limitations of the GCS in ventilated patients, this factor is less considered in the other components of the SOFA score [ 17 ]. Moreover, when a sole focus on the SOFA score after several modules has been exhausted, thus no longer demonstrating an increase in scores, then there will be an increased misdetection rate.…”

Section: Discussionmentioning

confidence: 99%

Detecting Sepsis in Patients with Severe Subarachnoid Hemorrhage during Critical Care

Flinspach

Konczalla

Seifert

et al. 2022

JCM

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Introduction: Sepsis and septic shock continue to have a very high mortality rate. Therefore, the last consensus-based sepsis guideline introduced the sepsis related organ failure assessment (SOFA) score to ensure a rapid diagnosis and treatment of sepsis. In neurosurgical patients, especially those patients with subarachnoid hemorrhage (SAH), there are considerable difficulties in interpreting the SOFA score. Therefore, our study was designed to evaluate the applicability of the SOFA for critical care patients with subarachnoid hemorrhage. Methods: Our retrospective monocentric study was registered (NCT05246969) and approved by the local ethics committee (# 211/18). Patients admitted to the Department of Neurosurgery at the Frankfurt University Hospital were enrolled during the study period. Results: We included 57 patients with 85 sepsis episodes of which 141 patients had SOFA score-positive results and 243 SIRS positive detections. We failed to detect a correlation between the clinical diagnosis of sepsis and positive SOFA or SIRS scores. Moreover, a significant proportion of sepsis that was incorrectly detected via the SOFA score could be attributed to cerebral vasospasms (p < 0.01) or a decrease in Glasgow Coma Scale (p < 0.01). Similarly, a positive SIRS score was often not attributed to a septic episode (49.0%). Discussion: Regardless of the fact that SAH is a rare disease, the relevance of sepsis detection should be given special attention in light of the long duration of therapy and sepsis prevalence. Among the six modules represented by the SOFA score, two highly modules were practically eliminated. However, to enable early diagnosis of sepsis, the investigator’s clinical views and synopsis of various scores and laboratory parameters should be highlighted. Conclusions: In special patient populations, such as in critically ill SAH patients, the SOFA score can be limited regarding its applicability. In particular, it is very important to differentiate between CVS and sepsis.

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Section: Discussionmentioning

confidence: 99%