Department of Trauma Research, Swedish Medical Center, Englewood, Colorado2Department of Trauma Research, St Anthony Hospital, Lakewood, Colorado.
InterMountain Neurosurgery, St Anthony Hospital, Lakewood, Colorado.
JAMA Surg. 2014 Jul;149(7):727-34. doi: 10.1001/jamasurg.2014.13.
The Glasgow Coma Scale (GCS) is used frequently to define the extent of neurologic injury in patients with a traumatic brain injury (TBI). Whether age affects the predictive ability of the GCS for severity of TBI (determined by the Abbreviated Injury Scale [AIS] score) remains unknown.
To investigate the effect of age on the association between the GCS and anatomic TBI severity.
DESIGN, SETTING, AND PARTICIPANTS: We examined all patients with a TBI, defined by diagnostic codes 850 to 854 from the International Classification of Diseases, Ninth Revision, Clinical Modification, who were admitted to 2 level I trauma centers from January 1, 2008, through December 31, 2012.
We compared elderly (≥65 years) and younger (18-64 years) adults with TBI.
We examined differences by age in GCS category (defined by emergency department GCS as severe [3-8], moderate [9-12], or mild [13-15]) at each level of TBI severity (head AIS score, 1 [minor] to 5 [critical]). Cochran-Armitage χ² trend tests and stepwise multivariate linear and logistic regression models were used.
During the study period, 6710 patients had a TBI (aged <65 years, 73.17%). Significant differences in GCS category by age occurred at each AIS score (P ≤ .01 for all). In particular, among patients with an AIS score of 5, most of the elderly patients (56.33%) had a mild neurologic deficit (GCS score, 13-15), whereas most of the younger patients (63.28%) had a severe neurologic deficit (GCS score, 3-8). After adjustment, the younger adults had increased odds of presenting with a severe neurologic deficit (GCS score, 3-8) at each of the following AIS scores: 1, 4.2 (95% CI, 1.0-17.6; P = .05); 2, 2.0 (1.0-3.7; P = .04); 3, 2.0 (1.2-3.5; P = .01); 4, 4.6 (2.8-7.5; P < .001); and 5, 3.1 (2.1-4.6; P < .001). The interaction between age and GCS for anatomic TBI severity remained significant after adjustment (estimate, -0.11; P = .005).
Age affects the relationship between the GCS score and anatomic TBI severity. Elderly TBI patients have better GCS scores than younger TBI patients with similar TBI severity. These findings have implications for TBI outcomes research and for protocols and research selection criteria that use the GCS.
格拉斯哥昏迷量表（GCS）常用于定义创伤性脑损伤（TBI）患者的神经损伤程度。年龄是否影响 GCS 对 TBI 严重程度的预测能力（由简明损伤量表[AIS]评分决定）仍不清楚。
研究年龄对 GCS 与解剖学 TBI 严重程度之间关联的影响。
设计、地点和参与者：我们检查了 2008 年 1 月 1 日至 2012 年 12 月 31 日期间从国际疾病分类第 9 修订版临床修正版的 850 至 854 个诊断代码中诊断为 TBI 的所有患者。两个 I 级创伤中心。
我们比较了年龄较大（≥65 岁）和年龄较小（18-64 岁）的成年人的 TBI。
我们检查了在每个 TBI 严重程度级别（头部 AIS 评分 1[轻微]至 5[严重]）下，GCS 类别（根据急诊科 GCS 定义为严重[3-8]、中度[9-12]或轻度[13-15]）按年龄的差异。采用 Cochran-Armitage χ²趋势检验和逐步多元线性和逻辑回归模型。
在研究期间，6710 名患者患有 TBI（年龄<65 岁，73.17%）。在每个 AIS 评分下，年龄对 GCS 类别的差异均具有统计学意义（所有 P≤.01）。特别是，在 AIS 评分为 5 的患者中，大多数老年患者（56.33%）有轻度神经缺损（GCS 评分 13-15），而大多数年轻患者（63.28%）有严重神经缺损（GCS 评分 3-8）。调整后，年轻成年人在以下每个 AIS 评分中出现严重神经缺损（GCS 评分 3-8）的可能性更高：1，4.2（95%CI，1.0-17.6；P=0.05）；2，2.0（1.0-3.7；P=0.04）；3，2.0（1.2-3.5；P=0.01）；4，4.6（2.8-7.5；P<.001）；和 5，3.1（2.1-4.6；P<.001）。调整后，年龄与 GCS 之间的解剖学 TBI 严重程度的交互作用仍然显著（估计值，-0.11；P=.005）。
年龄影响 GCS 评分与解剖学 TBI 严重程度之间的关系。老年 TBI 患者的 GCS 评分优于严重程度相似的年轻 TBI 患者。这些发现对 TBI 结局研究以及使用 GCS 的方案和研究选择标准具有重要意义。
