Summary

External validation of the Glasgow Coma Scale-Pupils in patients with severe head injury

Jesús Abelardo Barea-Mendoza1, Juan Antonio Llompart-Pou2, Jon Pérez-Bárcena2, Manuel Quintana-Díaz3, Lluís Serviá-Goixart4, Francisco Guerrero-López5, Javier González-Robledo6, Ismael Molina-Díaz7, Juncal Sánchez Arguiano8, Mario Chico-Fernández1, en representación del grupo de Trabajo de Neurointensivismo y Trauma de la SEMICYUC

Affiliation of the authors

1Trauma and Emergency ICU, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain. 2Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma, Spain. 3Service of Intensive Care Medicine, Hospital Universitario La Paz, Madrid, Spain. 4Intensive Care Medicine Service, Hospital Universitari Arnau de Vilanova, Universitat de Lleida. IRBLleida. Lleida, Spain. 5Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain. 6Service of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain. 7Service of Intensive Care Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain. 8Service of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

DOI

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Barea-Mendoza JA, Llompart-Pou JA, Pérez-Bárcena J, Quintana-Díaz M, Serviá-Goixart L, Guerrero-López F, et al. External validation of the Glasgow Coma Scale-Pupils in patients with severe head injury. Emergencias. 2023;35:39-43

Summary

Objectives.

To compare the ability of the Glasgow Coma Scale (GCS) score, the GCS Pupils (GCS-P) score, and the Pupil Reactivity Score (PRS) to predict mortality in patients with severe head injury.

Methods.

Retrospective analysis of all patients with severe head injury and initial GCS scores of 8 or lower on initial evaluation for whom records included pupil dilation information and clinical course after admission to intensive care units of participating hospitals. We assessed the ability of each of the 3 scores (GCS, GCS-P, and PRS) to predict mortality using discrimination analysis. Discrimination was estimated by calculating the areas under the receiver operating characteristic curves (AUC) and 95% CIs.

Results.

A total of 1551 patients with severe head injury and pupil dilation records were studied. The mean age was 50 years, 1190 (76.7%) were males, and 592 (38.2%) died. No pupil dilation was observed in 905 patients (58.3%), 362 (23.3%) had unilateral mydriasis, and 284 (18.3%) had bilateral mydriasis. The GCS-P score was significantly better at predicting mortality, with an AUC of 0.77 (95% CI, 0.74-0.79), versus 0.69 (95% CI, 0.67-0.72) for the GCS, and 0.75 (95% CI, 0.72-0.77) for the PRS. As the GCS-P score decreased, mortality increased.
Conclusion. The GCS-P was more useful than the GCS for predicting death after severe head injury.

 

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