Basak Debojit, Chatterjee Shamita, Attergrim Jonatan, Sharma Mohan Raj, Soni Kapil Dev, Verma Sukriti, GerdinWärnberg Martin, Roy Nobhojit
IPGME&R-SSKM Hospital, Kolkata, India.
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
Injury. 2023 Jan;54(1):93-99. doi: 10.1016/j.injury.2022.09.035. Epub 2022 Sep 23.
Glasgow Coma Scale (GCS) is one of the most commonly used trauma scores and is a good predictor of outcome in traumatic brain injury (TBI) patients. There are other more complex scores with additional physiological parameters. Whether they discriminate better than GCS in predicting mortality in TBI patients is debatable. The aim of this study was to compare the discrimination of GCS with that of MGAP, GAP, RTS and KTS for 24-hour and 30-day in-hospital mortality in adult TBI patients, in a resource limited LMIC setting.
We analysed data from the multicentre, observational trauma cohort Towards Improved Trauma Care Outcome (TITCO) in India. We included all patients 18 years or older, admitted from the emergency department with TBI. The Area Under the Receiver Operating Characteristic (AUROC) curve was used to quantify and compare the discrimination of all scores: GCS; Revised Trauma Score (RTS); mechanism, GCS, age, systolic blood pressure (MGAP); GCS, age, systolic blood pressure (GAP) and Kampala Trauma Score (KTS) in the prediction of 24-hour and 30-day in-hospital mortality.
A total of 3306 TBI patients were included in this study. The majority were within the GCS range 3-8. The commonest mechanism of injury was road traffic injuries [1907(58.0%)]. In-hospital mortality was 27.2% (899). There was no significant difference in discrimination in 24-hour in-hospital mortality when comparing GCS with MGAP and GAP. While GCS performed better than KTS, RTS performed better than GCS. For 30-day in-hospital mortality, GCS discriminated significantly better compared with KTS, but there was no significant difference when compared to MGAP and RTS. GAP discriminated significantly better when compared with GCS.
This study shows that the discrimination of GCS is comparable to that of more complex trauma scores in predicting 24-hour and 30-day in-hospital mortality in adult TBI patients in a resource limited LMIC setting.
格拉斯哥昏迷量表（GCS）是最常用的创伤评分之一，是创伤性脑损伤（TBI）患者预后的良好预测指标。还有其他更复杂的包含额外生理参数的评分。在预测TBI患者死亡率方面，它们是否比GCS具有更好的区分度存在争议。本研究的目的是在资源有限的低收入和中等收入国家（LMIC）环境中，比较GCS与MGAP、GAP、RTS和KTS对成年TBI患者24小时和30天院内死亡率的区分度。
我们分析了印度多中心观察性创伤队列“改善创伤护理结果”（TITCO）的数据。我们纳入了所有18岁及以上从急诊科收治的TBI患者。采用受试者工作特征曲线下面积（AUROC）来量化和比较所有评分的区分度：GCS；修订创伤评分（RTS）；机制、GCS、年龄、收缩压（MGAP）；GCS、年龄、收缩压（GAP）和坎帕拉创伤评分（KTS）对24小时和30天院内死亡率的预测。
本研究共纳入3306例TBI患者。大多数患者的GCS评分在3 - 8分之间。最常见的损伤机制是道路交通伤[1907例（58.0%）]。院内死亡率为27.2%（899例）。比较GCS与MGAP和GAP时，24小时院内死亡率的区分度无显著差异。虽然GCS的表现优于KTS，但RTS的表现优于GCS。对于30天院内死亡率，GCS与KTS相比区分度显著更好，但与MGAP和RTS相比无显著差异。GAP与GCS相比区分度显著更好。
本研究表明，在资源有限的LMIC环境中，对于成年TBI患者24小时和30天院内死亡率的预测，GCS的区分度与更复杂的创伤评分相当。
