BACKGROUND: The Glasgow Coma Scale (GCS) classifies traumatic brain injuries (TBIs) as mild (14-15), moderate (9-13), or severe (3-8). The Advanced Trauma Life Support modified this classification so that a GCS score of 13 is categorized as mild TBI. We investigated the effect of this modification on mortality prediction, comparing patients with a GCS score of 13 classified as moderate TBI (classic model) to patients with GCS score of 13 classified as mild TBI (modified model). METHODS: We selected adult TBI patients from the Pennsylvania Outcome Study database. Logistic regressions adjusting for age, sex, cause, severity, trauma center level, comorbidities, and isolated TBI were performed. A second evaluation included the time trend of mortality. A third evaluation also included hypothermia, hypotension, mechanical ventilation, screening for drugs, and severity of TBI. Discrimination of the models was evaluated using the area under receiver operating characteristic curve (AUC). Calibration was evaluated using the Hosmer-Lemershow goodness of fit test. RESULTS: In the first evaluation, the AUCs were 0.922 (95% CI, 0.917-0.926) and 0.908 (95% CI, 0.903-0.912) for classic and modified models, respectively. Both models showed poor calibration (p < 0.001). In the third evaluation, the AUCs were 0.946 (95% CI, 0.943-0.949) and 0.938 (95% CI, 0.934-0.940) for the classic and modified models, respectively, with improvements in calibration (p = 0.30 and p = 0.02 for the classic and modified models, respectively). CONCLUSION: The lack of overlap between receiver operating characteristic curves of both models reveals a statistically significant difference in their ability to predict mortality. The classic model demonstrated better goodness of fit than the modified model. A GCS score of 13 classified as moderate TBI in a multivariate logistic regression model performed better than a GCS score of 13 classified as mild.
BACKGROUND: The Glasgow Coma Scale (GCS) classifies traumatic brain injuries (TBIs) as mild (14-15), moderate (9-13), or severe (3-8). The Advanced Trauma Life Support modified this classification so that a GCS score of 13 is categorized as mild TBI. We investigated the effect of this modification on mortality prediction, comparing patients with a GCS score of 13 classified as moderate TBI (classic model) to patients with GCS score of 13 classified as mild TBI (modified model). METHODS: We selected adult TBIpatients from the Pennsylvania Outcome Study database. Logistic regressions adjusting for age, sex, cause, severity, trauma center level, comorbidities, and isolated TBI were performed. A second evaluation included the time trend of mortality. A third evaluation also included hypothermia, hypotension, mechanical ventilation, screening for drugs, and severity of TBI. Discrimination of the models was evaluated using the area under receiver operating characteristic curve (AUC). Calibration was evaluated using the Hosmer-Lemershow goodness of fit test. RESULTS: In the first evaluation, the AUCs were 0.922 (95% CI, 0.917-0.926) and 0.908 (95% CI, 0.903-0.912) for classic and modified models, respectively. Both models showed poor calibration (p < 0.001). In the third evaluation, the AUCs were 0.946 (95% CI, 0.943-0.949) and 0.938 (95% CI, 0.934-0.940) for the classic and modified models, respectively, with improvements in calibration (p = 0.30 and p = 0.02 for the classic and modified models, respectively). CONCLUSION: The lack of overlap between receiver operating characteristic curves of both models reveals a statistically significant difference in their ability to predict mortality. The classic model demonstrated better goodness of fit than the modified model. A GCS score of 13 classified as moderate TBI in a multivariate logistic regression model performed better than a GCS score of 13 classified as mild.
Authors: Ian G Stiell; Catherine M Clement; Brian H Rowe; Michael J Schull; Robert Brison; Daniel Cass; Mary A Eisenhauer; R Douglas McKnight; Glen Bandiera; Brian Holroyd; Jacques S Lee; Jonathan Dreyer; James R Worthington; Mark Reardon; Gary Greenberg; Howard Lesiuk; Iain MacPhail; George A Wells Journal: JAMA Date: 2005-09-28 Impact factor: 56.272
Authors: Marion Smits; Diederik W J Dippel; Gijs G de Haan; Heleen M Dekker; Pieter E Vos; Digna R Kool; Paul J Nederkoorn; Paul A M Hofman; Albert Twijnstra; Hervé L J Tanghe; M G Myriam Hunink Journal: JAMA Date: 2005-09-28 Impact factor: 56.272
Authors: Nino A Mushkudiani; Doortje C Engel; Ewout W Steyerberg; Isabella Butcher; Juan Lu; Anthony Marmarou; Frans Slieker; Gillian S McHugh; Gordon D Murray; Andrew I R Maas Journal: J Neurotrauma Date: 2007-02 Impact factor: 5.269
Authors: David W Wright; Tamara R Espinoza; Lisa H Merck; Jonathan J Ratcliff; Anika Backster; Donald G Stein Journal: Acad Emerg Med Date: 2014-11-24 Impact factor: 3.451
Authors: Young Hwan Lee; Young Taeck Oh; Won Woong Lee; Hee Cheol Ahn; You Dong Sohn; Ji Yun Ahn; Yong Hun Min; Hyun Kim; Seung Wook Lim; Kui Ja Lee; Dong Hyuk Shin; Sang O Park; Seung Min Park Journal: Intern Emerg Med Date: 2016-06-13 Impact factor: 3.397
Authors: Jennifer S Albrecht; Maureen McCunn; Deborah M Stein; Linda Simoni-Wastila; Gordon S Smith Journal: J Trauma Acute Care Surg Date: 2016-09 Impact factor: 3.313
Authors: Cyrus Elahi; Thiago Augusto Hernandes Rocha; Núbia Cristina da Silva; Francis M Sakita; Ansbert Sweetbert Ndebea; Anthony Fuller; Michael M Haglund; Blandina T Mmbaga; João Ricardo Nickenig Vissoci; Catherine A Staton Journal: Neurosurg Focus Date: 2019-11-01 Impact factor: 4.047
Authors: Shivayogi V Hiremath; Amol M Karmarkar; Amit Kumar; Donna L Coffman; Ralph J Marino Journal: J Spinal Cord Med Date: 2021-02-19 Impact factor: 1.985
Authors: Elif Soysal; Christopher M Horvat; Dennis W Simon; Michael S Wolf; Elizabeth Tyler-Kabara; Barbara A Gaines; Robert S B Clark; Patrick M Kochanek; Hülya Bayir Journal: Pediatr Crit Care Med Date: 2021-11-01 Impact factor: 3.971