Glasgow Coma Scale in the Prediction of Outcome after Early Aneurysm Surgery

Gotoh, Osamu; Tamura, Akira; Yasui, Nobuyuki; Suzuki, Akifumi; Hadeishi, Hiromu; Sano, Keiji

doi:10.1097/00006123-199607000-00005

Cited by 80 publications

(54 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The JCS is widely used for the assessment of impaired consciousness in patients with SAH in Japan. 2,12,14,25,32 Although the JCS cannot assess neurological impairment other than diminished consciousness, the JCS score on admission had the greatest impact on the outcomes of patients with SAH. 9 In addition, JCS scores have been reported to correlate with stroke outcomes.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

“…29 Therefore, we believe that the JCS is sufficient for clinical grade assessment in patients with SAH. However, as an increasing number of stroke researchers have used JCS scores in recent Japanese DPC database studies, 2,9,12,14,25,30,33 it may be necessary to compare the JCS scoring system with more typical grading scales. Third, the DPC database includes information collected only during hospitalization; thus, we were unable to evaluate long-term outcomes.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

Kurogi

Kada

Nishimura

et al. 2018

Journal of Neurosurgery

Self Cite

View full text Add to dashboard Cite

ABBREVIATIONS BRAT = Barrow Ruptured Aneurysm Trial; CCI = Charlson Comorbidity Index; CSC = comprehensive stroke center; DPC = Diagnosis Procedure Combination; HAC = hospital-acquired condition; ISAT = International Subarachnoid Aneurysm Trial; JCS = Japan Coma Scale; mRS = modified Rankin Scale; PPV = positive predictive value; PSI = patient safety indicator; RCT = randomized controlled trial; SAH = subarachnoid hemorrhage. OBJECTIVE Although heterogeneity in patient outcomes following subarachnoid hemorrhage (SAH) has been observed across different centers, the relative merits of clipping and coiling for SAH remain unknown. The authors sought to compare the patient outcomes between these therapeutic modalities using a large nationwide discharge database encompassing hospitals with different comprehensive stroke center (CSC) capabilities. METHODS They analyzed data from 5214 patients with SAH (clipping 3624, coiling 1590) who had been urgently hospitalized at 393 institutions in Japan in the period from April 2012 to March 2013. In-hospital mortality, modified Rankin Scale (mRS) score, cerebral infarction, complications, hospital length of stay, and medical costs were compared between the clipping and coiling groups after adjustment for patient-level and hospital-level characteristics by using mixedmodel analysis. RESULTS Patients who had undergone coiling had significantly higher in-hospital mortality (12.4% vs 8.7%, OR 1.3) and a shorter median hospital stay (32.0 vs 37.0 days, p < 0.001) than those who had undergone clipping. The respective proportions of patients discharged with mRS scores of 3-6 (46.4% and 42.9%) and median medical costs (thousands US$, 35.7 and 36.7) were not significantly different between the groups. These results remained robust after further adjustment for CSC capabilities as a hospital-related covariate. SUBMITTED

show abstract

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

Kurogi

Kada

Nishimura

et al. 2018

Journal of Neurosurgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…The GCS initially intended to assess the level of consciousness after head injury in neurosurgical intensive care unit is widely used in neurological patients beyond the original intentions in the context of outcome prediction (e.g., [11]. ), neurosurgical prognostic indicator (e.g., [12]. ), cerebral dysfunction measurement (e.g., [13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

et al. 2011

View full text Add to dashboard Cite

Background The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liège Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state. Methods FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) braindamaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Interrater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136). Results GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit. Conclusions The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales.

show abstract

“…Two studies of the JCS in patients with aneurysmal subarachnoid hemorrhage reported that the preoperative level of consciousness as measured by JCS is well correlated with the outcome. 6,30) However, the validity of this scale for head injury has not been clarified. CT is widely available and less expensive in Japan (1/2 to CT: computed tomography, GCS: Glasgow Coma Scale.…”

Section: Introductionmentioning

confidence: 99%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

View full text Add to dashboard Cite

The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

show abstract

Glasgow Coma Scale in the Prediction of Outcome after Early Aneurysm Surgery

Cited by 80 publications

References 12 publications

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

Indications for Computed Tomography in Patients With Mild Head Injury

Contact Info

Product

Resources

About