Glasgow Coma Scale Scoring is Often Inaccurate

Bledsoe, Bryan E; Casey, Michael J.; Feldman, Jay; Johnson, Larry; Diel, Scott; Forred, Wes; Gorman, Codee

doi:10.1017/s1049023x14001289

Cited by 94 publications

(73 citation statements)

References 21 publications

(54 reference statements)

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“…42 Further, scoring of GCS may be compromised in patients who are intubated and sedated, and in an acute setting has lower inter-rater reliability. 43 These factors may explain why we did not observe differences in tau levels by injury severity. However, our study showed a relationship of tau levels with injury severity by demonstrating a correlation between duration of PTA and Day 30 tau, and between injury severity by Marshall Grade and tau levels at Day 30.…”

mentioning

confidence: 81%

Increases of Plasma Levels of Glial Fibrillary Acidic Protein, Tau, and Amyloid β up to 90 Days after Traumatic Brain Injury

Bogoslovsky

Wilson

Yao

et al. 2017

Journal of Neurotrauma

175

126

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Glial fibrillary acidic protein (GFAP), microtubule-associated protein tau, and amyloid b peptide (Ab42) have been proposed as diagnostic and prognostic biomarkers in traumatic brain injury (TBI). Single molecule array (Simoa) is a novel technology that employs highly sensitive immunoassays for accurate measurements of candidate biomarkers found at low concentration in biological fluids. Our objective was to trace the trajectory of tau, GFAP, and Ab42 levels in plasma from the acute through subacute stages after TBI, compared with controls. Samples from 34 TBI subjects enrolled in the Citicoline Brain Injury Treatment Trial (COBRIT) were studied. Injury severity was assessed by Glasgow Coma Scale (GCS) and admission CT. Glasgow Outcome Scale Extended (GOSE) was assessed 6 months after injury. Plasma was collected within 24 h (Day 0), and 30 and 90 days after the TBI. Plasma collected from 69 healthy volunteers was used for comparison. At every time point, increases were noted in plasma GFAP ( p < 0.0001 for all comparisons), tau ( p < 0.0001, p < 0.0001, and p = 0.0044, at Days 0, 30, and 90, respectively), and Ab42 ( p < 0.001, p < 0.0001, and p = 0.0203, respectively) in TBI cases compared with controls. The levels were maximal at Day 0 for GFAP and tau and at Day 30 for Ab42. Area under curve (AUC) analyses for Day 0 GFAP and tau were excellent for discrimination of complicated mild TBI (cmTBI) from controls (0.936 and 0.901, correspondingly). Discriminant component analysis (DCA) for all three biomarkers at Days 0 and 30 differentiated controls from cmTBI (91.1% and 89.7% correctly classified, at each time point). Duration of post-traumatic amnesia (PTA) correlated weakly with tau levels at 30 days (Spearman's r = 0.40; 95% CI 0.0003-0.60, p = 0.044). The Marshall CT Grade on admission correlated weakly with Day 30 tau levels (Spearman's r = 0.41; 95% CI 0.04-0.68, p = 0.027). Day 30 Ab42 correlated with GOSE (standardized b -0.486, p = 0.042). GFAP, tau and Ab42 were increased up to 90 days after TBI compared with controls. Total tau levels correlated with clinical and radiological variables of TBI severity. Plasma Ab42 correlated with clinical outcome. Combination of all three biomarkers at Days 0 and 30 can be used to differentiate controls from cmTBI populations, and may be useful as biomarkers of TBI in both acute and subacute phases.

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mentioning

confidence: 81%

Increases of Plasma Levels of Glial Fibrillary Acidic Protein, Tau, and Amyloid β up to 90 Days after Traumatic Brain Injury

Bogoslovsky

Wilson

Yao

et al. 2017

Journal of Neurotrauma

175

126

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“…Another limitation is the heterogeneity of our cohort, comprising of mild-to-severe TBI cases (see Supplementary Table S1). TBI severity has historically been categorized using GCS, however GCS has obvious limitations in its subjectivity (Bledsoe et al, 2014) and the fact that the patients may be sedated (Stocchetti et al, 2004). In the current study, TBI patients in need of neuro-intensive care for their head injuries were included which we believe represents a clinically valid and reproducible cohort of TBI patients and as can be seen by the AIS, all suffered from structural severe TBI.…”

Section: Discussionmentioning

confidence: 99%

Functional resting-state fMRI connectivity correlates with serum levels of the S100B protein in the acute phase of traumatic brain injury

Thompson

Thelin

Lilja

et al. 2016

NeuroImage: Clinical

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The S100B protein is an intra-cellular calcium-binding protein that mainly resides in astrocytes in the central nervous system. The serum level of S100B is used as biomarker for the severity of brain damage in traumatic brain injury (TBI) patients. In this study we investigated the relationship between intrinsic resting-state brain connectivity, measured 1–22 days (mean 8 days) after trauma, and serum levels of S100B in a patient cohort with mild-to-severe TBI in need of neuro-intensive care in the acute phase. In line with previous investigations, our results show that the peak level of S100B acquired during the acute phase of TBI was negatively correlated with behavioral measures (Glasgow Outcome Score, GOS) of functional outcome assessed 6 to 12 months post injury. Using a multi-variate pattern analysis-informed seed-based correlation analysis, we show that the strength of resting-state brain connectivity in multiple resting-state networks was negatively correlated with the peak of serum levels of S100B. A negative correspondence between S100B peak levels recorded 12–36 h after trauma and intrinsic connectivity was found for brain regions located in the default mode, fronto-parietal, visual and motor resting-state networks. Our results suggest that resting-state brain connectivity measures acquired during the acute phase of TBI is concordant with results obtained from molecular biomarkers and that it may hold a capacity to predict long-term cognitive outcome in TBI patients.

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“…In an attempt to determine how accurately emergency department healthcare professionals can determine the GCS in simulated patient encounters (Bledsoe et al . ) prospective observational American study of the accuracy of GCS scoring found out of a total of 2084 GCS observations the overall accuracy was 33·1%. Specifically, the verbal, eye‐opening and motor scores were only accurate and correct in 69, 61·2 and 59·8% of assessments respectively.…”

Section: Methodsmentioning

confidence: 99%

The Glasgow Coma Scale and evidence‐informed practice: a critical review of where we are and where we need to be

Braine

Cook

2016

Journal of Clinical Nursing

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Glasgow Coma Scale Scoring is Often Inaccurate

Abstract: Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.

Cited by 94 publications

References 21 publications

Increases of Plasma Levels of Glial Fibrillary Acidic Protein, Tau, and Amyloid β up to 90 Days after Traumatic Brain Injury

Increases of Plasma Levels of Glial Fibrillary Acidic Protein, Tau, and Amyloid β up to 90 Days after Traumatic Brain Injury

Functional resting-state fMRI connectivity correlates with serum levels of the S100B protein in the acute phase of traumatic brain injury

The Glasgow Coma Scale and evidence‐informed practice: a critical review of where we are and where we need to be

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