Prognosis and futility in neurosurgical emergencies: A review

Anderson, Emily E.; Kryzanski, James

doi:10.1016/j.clineuro.2020.105851

Cited by 8 publications

(1 citation statement)

References 77 publications

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“…Nevertheless, any attempt to link the need for medical and surgical interventions with the level of consciousness lacks scientific justification, since severe disturbance of consciousness is frequently not the sole indication for intubation [ 39 ]. Further, the decision to proceed to a neurosurgical intervention is multifactorial, and a severe consciousness disturbance might render surgery pointless [ 40 , 41 ]. On the contrary, discriminating comatose patients is fundamental.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale

Anestis

Marinos

Tsitsopoulos

2023

Eur J Trauma Emerg Surg

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Background Various tools simpler than the Glasgow Coma Scale (GCS) have been proposed for the assessment of consciousness. In this study, the validity of three coma scales [Simplified Motor Scale, Modified GCS Motor Response, and AVPU (alert, verbal, painful, unresponsive)] is evaluated for the recognition of coma and the prediction of short- and long-term mortality and poor outcome. The predictive validity of these scales is also compared to the GCS. Methods Patients treated in the Department of Neurosurgery and the Intensive Care Unit in need of consciousness monitoring were assessed by four raters (two consultants, a resident and a nurse) using the GCS. The corresponding values of the simplified scales were estimated. Outcome was recorded at discharge and at 6 months. Areas Under the Receiver Operating Characteristic Curve (AUCs) were calculated for the prediction of mortality and poor outcome, and the identification of coma. Results Eighty-six patients were included. The simplified scales showed good overall validity (AUCs > 0.720 for all outcomes of interest), but lower than the GCS. For the identification of coma and the prediction of long-term poor outcome, the difference was significant (p < 0.050) for all the ratings of the most experienced rater. The validity of these scales was comparable to the GCS only in predicting in-hospital mortality, but without this being consistent for all raters. Conclusion The simplified scales showed inferior validity than the GCS. Their potential role in clinical practice needs further investigation. Thus, the replacement of the GCS as the main scale for consciousness assessment cannot be currently supported.

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Section: Discussionmentioning

confidence: 99%