Bae et al reported a modified Glasgow Coma Scale for evaluating a patient with traumatic brain injury (TBI). This is superior to the original Glasgow coma scale for predicting the patient's prognosis. The authors are from Hanyang University Medical Center in Seoul.
Patient selection: adult with traumatic brain injury (age range around 37 to 60)
Parameters:
(1) hemoglobin in g/dL
(2) platelet count in 10^9/L
(3) prothrombin time in seconds
(4) serum LDH in U/L
|
Parameter
|
Finding
|
Points
|
|
hemoglobin
|
>= 13.0 g/dL
|
0
|
|
|
< 13.0 g/dL
|
1
|
|
platelet count
|
>= 150 * 10^9/L
|
0
|
|
|
< 150 * 10^9/L
|
1
|
|
prothrombin time
|
< 13.2 seconds
|
0
|
|
|
>= 13.2 seconds
|
1
|
|
serum LDH
|
< 271 U/L
|
0
|
|
|
>= 271 U/L
|
1
|
factor score =
= SUM(points for all of the parameters)
modified Glasgow coma scale =
= (Glasgow coma scale) - (factor score)
Interpretation:
• minimum factor score: 0
• maximum factor score: 4
• minimum modified GCS: -1
• maximum modified GCS: 15
• A modified GCS < 10 was associated with in-hospital mortality.
• A modified GCS < 8 was associated with an unfavorable neurological outocme.
Performance:
• The modified GCS had an area under the ROC curve of 0.84 for in-hospital mortality.
• The modified GCS had an area under the ROC curve of 0.79 for unfavorable neurological outcome (Glasgow Outcome Scale of 1 to 3).
