Adding scores from a simple eye test to scores of the Glasgow Coma Scale (GCS) helps doctors predict mortality and outcomes in patients with brain trauma more accurately, according to a study published in the Journal of Neurosurgery on April 10.
Assessing Severity Post-Trauma
Doctors use several measures to predict a patient's prognosis in the first few hours of a traumatic brain injury (TBI), including the GCS, which measures whether patients can open their eyes, speak, or move. A person’s total score on the GCS—a minimum of 3 indicates deep coma, a maximum of 15 indicates full consciousness—indicates his or her level of consciousness after brain trauma.
In addition to the GCS score, doctors also look at pupil response. Abnormalities such as an irregular pupil size or shape, or a delayed or nonreactive pupil can be indicative of significant head trauma. A score of 2 means both pupils are non-reactive to light; a score of 1 means one pupil is non-reactive; and a score of 0 means neither pupil is non-reactive.
Improving GCS Score
To find out if adding scores from pupil response to the GCS scores would improve clinicians’ ability to predict mortality or an unfavorable outcome, the creators of the GCS and researchers at the University of Edinburgh in Scotland assessed the health records of more than 15,000 patients from the databases of two trials, CRASH (Corticosteroid Randomization After Significant Head Injury) and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI). Of the IMPACT patients, 81 percent had severe head injuries compared to 39 in CRASH.
Combined GCS Score Improves Accuracy of Prognosis
Simply adding pupil reactivity scores to the GCS score was as accurate as more complex methods of evaluating brain trauma. The combined score also extended information for physicians. For example, in patients with a GCS score of 3, physicians predicted a mortality rate of 51 percent and an unfavorable outcome of 70 percent. For patients with a GCS-P score of 1, physicians predicted a mortality rate and unfavorable outcome rate of 74 percent and 90 percent, respectively.
GCS-P Score Implications
The researchers urge the clinical community to assess and evaluate GCS-P while cautioning that clinical assessment tools should not be the sole basis for predicting outcome and determining how to treat patients with brain trauma.
To understand the differences between a coma, a persistent vegetative state, and brain death, click here.