What's New in Emergencies Trauma and Shock? Studying glasgow outcome scores at discharge and final outcomes in severe head injury.

In the article “Can glasgow outcome score at discharge represent final outcome in severe head injury?” authors discuss the role of GOS as a representative measure of outcome in head injury.[1] Although the mortality of TBI has decreased substantially in recent years the disability due to TBI has not appreciably reduced.[2] The present study discusses the role of glasgow outcome scale at the time of discharge to predict outcome in patients of traumatic brain injury who were followed up after decompressive craniectomy and provides a baseline data in this sub-group of patients and also provides an opportunity to further explore the role of glasgow coma scale to follow up the patients with severe head injuries as a whole. Glasgow outcome scale (GOS) a five-point scale was proposed by Jennett in 1975 to assess the outcome of comatose patients after TBI and one of the oldest and most widely implemented of the outcome measures.[34] GOS has also been reduced to two categories (dichotomization): favorable versus unfavorable where favorable includes; good recovery and moderate disability and unfavorable includes severe disability, vegetative state and death. The majority of patients (70%) with a severe TBI will fall into the two extremes: those with good recovery and those who die.[2] Although the GOS has been utilized extensively, it has been criticized as suffering from ceiling effects and being insufficiently sensitive to subtle but functionally limiting deficits in cognition, mood and behavior.[5] Dichotomization of GOS scores is usually performed for clinical reasons and for simplicity of interpreting the difference of outcomes between two trial arms and the use of a dichotomized GOS lacks precision.[2] To overcome the poor precision of GOS various outcome scales have been proposed since 1981 to assess disability following TBI.[6-8] A few, commonly used are GOS with or without extended scores, Disability Rating Scale, Functional Independence Measure, Community Integration Questionnaire, and the Functional Status Examination.[2] Nevertheless, the use of GOS has been cited in the neurotrauma literature on more than several hundred occasions, and it remains the most widely used and accepted instrument available.[9] Standardized inpatient protocol on monitoring, intervention, and outcome recording should be adopted to make future comparisons more useful and to promote benchmarking between trauma centers in order to improve care for patients with severe traumatic brain injury.[10] We agree with the author that there is lack of proper rehabilitative facilities and the patients may be discharged to home-based physiotherapy and rehabilitation performed by the relatives with negligible rehabilitative scientific inputs to most of the patients with questionable potential benefits. It is beyond doubt that this is a largely unexplored area in resource poor developing countries and can be an area where major inputs and efforts are required for building rehabilitative facilities and to get the best possible of these services for better functional outcome and for a better quality of life in survivors with traumatic brain injuries.