Glasgow coma scale compared to other trauma scores in discriminating in-hospital mortality of traumatic brain injury patients admitted to urban Indian hospitals: A multicentre prospective cohort study

Basak, Debojit; Sk, Chatterjee; Attergrim, Jonatan; Sharma, Mohan Raj; Soni, Kapil Dev; Verma, Shailendra Kumar; GerdinWärnberg, Martin; Roy, Nobhojit

doi:10.1016/j.injury.2022.09.035

Cited by 6 publications

(9 citation statements)

References 26 publications

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“…4,6,10,[12][13][14][15][16][17][18][19] There is a clear majority of male patients suffering from traumatic events (82.08%), which can also be seen in several other studies. 4,6,9,10,[12][13][14][15][16][17][18][20][21][22] The leading cause of traumatic events (55.83%) was RTAs, followed by falls (33.75%). These data were also confirmed from other studies conducted on similar topics.…”

Section: Discussionmentioning

confidence: 90%

“…There are several studies to confirm these findings, and several others that contradict them. 4 , 13 , 15 , 16 , 26 , 29 The TRISS also performed weekly for outcome prediction. However, there are almost an equal amount of studies confirming and contradicting this.…”

Section: Discussionmentioning

confidence: 99%

“…These data were also confirmed from other studies conducted on similar topics. 4,6,10,[12][13][14][15][18][19][20] The WHO report on road traffic injury prevention identifies various risk factors associated with RTAs. These factors include those related to exposure, such as economic and demographic considerations, land-use planning practices, and the integration of road functions with speed and design.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores

Gupta,

Kshirsagar,

Naik

et al. 2024

Indian Journal of Critical Care Medicine

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Aim This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Methods Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Results Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Conclusion Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. Clinical significance This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. How to cite this article Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475–482.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores

Gupta,

Kshirsagar,

Naik

et al. 2024

Indian Journal of Critical Care Medicine

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“…[ 5 ] Previous studies have found that 56–70% of patients were referred to an emergency setup from other smaller or less equipped health facilities. [ 7 10 11 ] Despite referrals from other healthcare setups, the proportion of patients receiving appropriate treatment at the referring hospital has been found to be dismally low (8%). [ 10 ] Some studies have found the absence of any prehospital trauma care in as much as 50–85% of trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Prehospital care and interfacility transfer of trauma patients before reaching the emergency of a level-1 trauma care center

Hansda,

Mishra,

Topno

et al. 2024

Journal of Family Medicine and Primary Care

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Background: Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. Materials and Methods: A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. Results: The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. Conclusion: The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care.

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“…However, in the TBI group, both shock and GCS, which constitute the rSIG, directly influenced the mortality. As mentioned earlier, GCS is closely related to the prognosis of patients with TBI [ 24 ]. Additionally, patients with TBI experience impaired autoregulation of the brain owing to increased intracranial pressure, and shock accelerates the decrease in brain perfusion, leading to irreversible global brain hypoxia [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study

Park,

Choi,

Kim

et al. 2024

BMC Emerg Med

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Background Early identification of patients at risk of potential death and timely transfer to appropriate healthcare facilities are critical for reducing the number of preventable trauma deaths. This study aimed to establish a cutoff value to predict in-hospital mortality using the reverse shock index multiplied by the Glasgow Coma Scale (rSIG). Methods This multicenter retrospective cohort study used data from 23 emergency departments in South Korea between January 2011 and December 2020. The outcome variable was the in-hospital mortality. The relationship between rSIG and in-hospital mortality was plotted using the shape-restricted regression spline method. To set a cutoff for rSIG, we found the point on the curve where mortality started to increase and the point where the slope of the mortality curve changed the most. We also calculated the cutoff value for rSIG using Youden's index. Results A total of 318,506 adult patients with trauma were included. The shape-restricted regression spline curve showed that in-hospital mortality began to increase when the rSIG value was less than 18.86, and the slope of the graph increased the most at 12.57. The cutoff of 16.5, calculated using Youden's index, was closest to the target under-triage and over-triage rates, as suggested by the American College of Surgeons, when applied to patients with an rSIG of 20 or less. In addition, in patients with traumatic brain injury, when the rSIG value was over 25, in-hospital mortality tended to increase as the rSIG value increased. Conclusions We propose an rSIG cutoff value of 16.5 as a predictor of in-hospital mortality in adult patients with trauma. However, in patients with traumatic brain injury, a high rSIG is also associated with in-hospital mortality. Appropriate cutoffs should be established for this group in the future.

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Glasgow coma scale compared to other trauma scores in discriminating in-hospital mortality of traumatic brain injury patients admitted to urban Indian hospitals: A multicentre prospective cohort study

Cited by 6 publications

References 26 publications

Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores

Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores

Prehospital care and interfacility transfer of trauma patients before reaching the emergency of a level-1 trauma care center

Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study

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