Zafonte R D, Hammond F M, Mann N R, Wood D L, Black K L, Millis S R
Rehabilitation Institute of Michigan, Detroit, USA.
Am J Phys Med Rehabil. 1996 Sep-Oct;75(5):364-9. doi: 10.1097/00002060-199609000-00012.
The Glasgow Coma Scale (GCS) is routinely used in the acute care setting after traumatic brain injury (TBI) to guide decisions in triage, based on its ability to predict morbidity and mortality. Although the GCS has been previously demonstrated to predict mortality, efficacy in prediction of functional outcome has not been established. The purpose of this study was to assess the value of the acute GCS in predicting functional outcome in survivors of TBI. This study used the Multicenter National Institute on Disability and Rehabilitation Research TBI Model Systems database of 501 patients who had received acute medical care and inpatient rehabilitation within a coordinated neurotrauma program for treatment of TBI. Initial and lowest 24 hr GCS scores were correlated with the following outcome measures: the Disability Rating Scale (DRS), Rancho Los Amigos Levels of Cognitive Functioning Scale (LCFS), and cognitive and motor components of the Functional Independence Measure (FIM(SM)-COG and FIM(SM)-M). Outcome data were collected at admission to and discharge from the inpatient TBI rehabilitation unit. Correlation analysis revealed only modest, but statistically significant, relationships between initial and lowest GCS scores and outcome variables. Initial and lowest GCS score comparison with outcome demonstrated the following correlation coefficients: admission DRS, -0.25 and -0.28; discharge DRS, -0.24 and -0.24; admission LCFS, 0.31 and 0.33; discharge LCFS, 0.27 and 0.25; admission FIM-COG, 0.36 and 0.37; discharge FIM-COG, 0.23 and 0.23; admission FIM-M, 0.31 and 0.31; discharge FIM-M, 0.25 and 0.21. The GCS as a single variable may have limited value as a predictor of functional outcome.
格拉斯哥昏迷量表（GCS）在创伤性脑损伤（TBI）后的急性护理环境中经常被用于指导分诊决策，这是基于其预测发病率和死亡率的能力。尽管先前已证明GCS可预测死亡率，但在预测功能结局方面的有效性尚未得到证实。本研究的目的是评估急性GCS在预测TBI幸存者功能结局中的价值。本研究使用了多中心国家残疾与康复研究所TBI模型系统数据库，该数据库包含501名在协调神经创伤项目中接受急性医疗护理和住院康复治疗的TBI患者。最初和最低的24小时GCS评分与以下结局指标相关：残疾评定量表（DRS）、兰乔洛斯阿米戈斯认知功能水平量表（LCFS）以及功能独立性测量的认知和运动部分（FIM(SM)-COG和FIM(SM)-M）。结局数据在患者入住和出院时收集自住院TBI康复单元。相关性分析显示，最初和最低的GCS评分与结局变量之间仅存在适度但具有统计学意义的关系。最初和最低GCS评分与结局的比较显示出以下相关系数：入院时DRS为-0.25和-0.28；出院时DRS为-0.24和-0.24；入院时LCFS为0.31和0.33；出院时LCFS为0.27和0.25；入院时FIM-COG为0.36和0.37；出院时FIM-COG为0.23和0.23；入院时FIM-M为0.31和0.31；出院时FIM-M为0.25和0.21。作为单一变量的GCS在预测功能结局方面可能价值有限。
