Part 1: The GCS-Pupils score: an extended index of clinical severity J Neurosurg 128:1612–1620, 2018 Simplifying the use of prognostic information in traumatic brain injury. Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL: Validation of a new coma scale: The FOUR score. Prognostic value and evolution of motor response and brain stem reflexes after severe head injury. Benzer A, Mitterschiffthaler G, Marosi M, Luef G, Pühringer F, De La Renotiere K, et al: Prediction of non-survival after trauma: Innsbruck Coma Scale.5 The GCS-P provides a uni-dimensional index of clinical severity onto which information about other key prognostic features, such as age, can be added in a simple format likely to be useful in clinical practice 6 ( GCS-P Charts). It may be useful in avoiding bias in decisions from individual clinicians’ perceptions, in drawing up guidelines and in describing findings in groups of patients. It expands on the GCS Score as a simple shorthand index of the severity of a patient’s clinical state and prognosis, especially in more severe injuries. The combined GCS-P is not intended to replace the role of separate assessment and reporting of each component of the Glasgow Coma Scale and pupil response in the care of individual patients. The fitted lines come from logistic regression models in which the GCS-P was treated as a continuous variable.4 Examination of the information yield measured using Nagelkerke’s R 2 confirmed that the combination was superior to either clinical feature alone and that the information from the simple arithmetic score was very close to that calculated by more complex models for integration Role of GCS-P Score Error bars show 95% confidence intervals. Mortality 6 months after head injury (left) and unfavourable outcomes (right) according to patient GCS-P score at admission. There was a continuous, fundamentally smooth, relationship between the combined GCS –P Score and mortality or failure to achieve an independent outcome.įigure 1. Impairment of pupil reactivity was associated with a worsening of outcome across the range of GCS Scores. The relationship between the combination of GCS Score and pupil score, and severity of a head injury as reflected in outcome, was examined in information on 15,900 patients drawn from the two largest available data sets (IMPACT and CRASH). The GCS-P is calculated by subtracting the Pupil Reactivity Score (PRS) from the Glasgow Coma Scale (GCS) total score: The Pupil Reactivity Score summarises Information about loss of pupil reactivity to light and is calculated as follows. Further information on the GCS Score can be accessed here. The GCS Score is derived by assigning notation to the level in each of the three subcomponents of the GCS and summing the results of a patient’s assessment. 1-3 In response, the GCS Pupils Score (GCS-P) was constructed to bring together information about a patient’s responsiveness as reflected in the GCS Score and the pupil reaction 4( Link). Nevertheless, there have been views that indices or scores that combine an assessment of ‘conscious level’ and ‘brain stem’ function may have a useful place. When it was described, features of focal dysfunction such as brainstem signs were not incorporated and instead were intended to be assessed separately. The Glasgow Coma Scale provides a clinical index of the ‘overall’ acute impairment of brain function, or so called ‘conscious level’.
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