Those who speak survive: The value of the verbal component of GCS in trauma

Abstract

Aim To evaluate the predictive value of the individual components of GCS in predicting the survival of trauma patients in the emergency department. Methods This is a post-hoc analysis of previously published data on trauma patients in Al Ain City. We obtained data on patients that presented with trauma to Al-Ain Hospital who were admitted for more than 24 hours or died at the Emergency Department or hospital from January 2014 to December 2017. Studied variables included demographics, vital signs, Glasgow Coma Scale (GCS), GCS components, Injury Severity Score (ISS), and in-hospital mortality. We entered factors found to have a p value of < 0.1 in univariate analysis into a direct logistic regression model to define factors that predict survival. Results There were 3519 trauma patients in the registry. The median (range) of age, respiratory rate, and ISS were significantly lower in patients who survived 31(0-105) versus 37 (1–76) years, p = 0.031; 18 (6–56) versus 22 (0–35) breaths per minutes, p = 0.019, and 4 (1–75) versus 16.5 (1–75), p < 0.001, respectively). Systolic blood pressure and GCS were significantly higher in patients who survived (median (range) 133 mmHg (21–265) versus 117mmHg (0-209), p = 0.003, and 15 (3–15) versus 6 (3–15), p < 0.001, respectively). Logistic regression analysis revealed that ISS and GCS-Verbal Response (GCS-VR) were significant predictors of survival. GCS-VR was the most significant predictor for survival, with Area Under the Curve of 0.89, p < 0.001. Conclusion In general trauma patients, acute trauma care professionals can use GCS-VR to predict survival instead of the total GCS score or ISS.