南非一家大型创伤中心对创伤性脑损伤患者简化运动评分的验证。

Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa.

作者信息

Buitendag J J P, Ras A, Kong V Y, Bruce J L, Laing G L, Clarke D L, Brysiewicz P

机构信息

Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

出版信息

S Afr Med J. 2018 Feb 1;108(2):90-93. doi: 10.7196/SAMJ.2017.v108i2.12757.

DOI:10.7196/SAMJ.2017.v108i2.12757

PMID:29429438

Abstract

BACKGROUND

This study used data from a large prospectively entered database to assess the efficacy of the motor score (M score) component of the Glasgow Coma Scale (GCS) and the Simplified Motor Score (SMS) in predicting overall outcome in patients with traumatic brain injury (TBI).

OBJECTIVE

To safely and reliably simplify the scoring system used to assess level of consciousness of trauma patients in the acute setting.

METHODS

A retrospective observational review of the Pietermaritzburg Metropolitan Trauma Service hybrid electronic medical registry database was performed during the period January 2013 - December 2015. Patients were classified into three groups using their GCS as an injury severity score. These were mild TBI (GCS 13 - 15), moderate TBI (GCS 9 - 12) and severe TBI (GCS <9). The Glasgow M score was specifically evaluated to determine the relationship between the individual motor component and patient outcome.

RESULTS

GCS scores and M scores were analysed in a total of 830 patients. There was a decline in survival rate when the M score on admission was ≤4. The decline was more significant when the M score was ≤3. Survival rates were 26.8% (11/41) for patients with an M score of 1, 63.6% (14/22) for those with a score of 2, 56.5% (13/23) for those with a score of 3, 80.0% (20/25) for those with a score of 4, and 95.5% (121/128) for those with a score of 5. Of 591 patients with an M score of 6, 580 (98.1%) survived. Mortality rose dramatically with declining SMS. This was highly significant. When the M score was plotted against mortality in 830 patients, there was a correct prediction in 769 cases (accuracy 92.7%, sensitivity 67.6%, specificity 95%). The area under the receiver operating characteristic (ROC) curve was 0.9037, with a standard deviation (area) of 0.0227. When comparing the SMS against mortality, the accuracy was 77.1%, the sensitivity 84.5% and the specificity 76.4%. The fitted ROC area was 0.891 and the empirical ROC area 0.86.

CONCLUSION

The M score component of the GCS and the SMS accurately predict outcome in patients with TBI. In cases where the full GCS is difficult to assess, the M score and SMS can be used safely as a triage tool.

摘要

背景

本研究使用来自一个大型前瞻性录入数据库的数据，以评估格拉斯哥昏迷量表（GCS）的运动评分（M评分）和简化运动评分（SMS）在预测创伤性脑损伤（TBI）患者总体预后方面的疗效。

目的

在急性情况下安全可靠地简化用于评估创伤患者意识水平的评分系统。

方法

对2013年1月至2015年12月期间彼得马里茨堡市立创伤服务混合电子医疗登记数据库进行回顾性观察性分析。使用GCS作为损伤严重程度评分将患者分为三组。分别为轻度TBI（GCS 13 - 15）、中度TBI（GCS 9 - 12）和重度TBI（GCS＜9）。专门评估格拉斯哥M评分，以确定个体运动成分与患者预后之间的关系。

结果

共分析了830例患者的GCS评分和M评分。入院时M评分≤4时生存率下降。当M评分≤3时下降更显著。M评分为1的患者生存率为26.8%（11/41），评分为2的患者为63.6%（14/22），评分为3的患者为56.5%（13/23），评分为4的患者为80.0%（20/25），评分为5的患者为95.5%（121/128）。在591例M评分为6的患者中，580例（98.1%）存活。随着SMS下降，死亡率急剧上升。这具有高度显著性。当在830例患者中绘制M评分与死亡率的关系图时，769例预测正确（准确率92.7%，敏感性67.6%，特异性95%）。受试者操作特征（ROC）曲线下面积为0.9037，标准差（面积）为0.0227。将SMS与死亡率进行比较时，准确率为77.1%，敏感性为84.5%，特异性为 76.4%。拟合ROC面积为0.891，经验ROC面积为0.86。