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External validation of the GCS-Pupils Score as an outcome predictor after traumatic brain injury in adults: a single-center experience

  • Original Article - Brain trauma
  • Published:
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Abstract

Objective

The GCS-Pupils (GCS-P) score is a recently described scoring system to aid outcome prediction in patients with traumatic brain injury (TBI). The aim of this study was to provide the first external validation of the GCS-P score by identifying independent predictors of outcome in TBI patients.

Methods

Review of prospective adult (≥ 16 years) TBI database at a tertiary neurosurgical center with a catchment population of 1.5 million over a 12-month period commencing October 2016. Multivariate logistic regression was used to identify predictors of discharge destination and 30-day mortality.

Results

Three hundred and fifty-eight patients were included. The median age was 60 years with a male predominance of 64%. The median GCS-P was 14 (interquartile range 12–15) and the commonest GCS-P category was mild (13–15; 238/358, 66%). Discharge destination was home in 69% of patients and rehab services or equivalent in 31%. Multivariate analysis identified age (p = 0.01), CT findings of an acute subdural hematoma (p = 0.01) or diffuse axonal injury (p = 0.02), and a neurosurgical operation (p = 0.02) as independent predictors of discharge destination. The 30-day mortality rate was 11%. Within the category of severe TBI (GCS-P ≤ 8), GCS-P was able to identify patients with a very high likelihood of 30-day mortality (GCS-P ≤ 4; 16/31, 52%). Multivariate analysis revealed the Charlson comorbidity score (p = 0.01), GCS-P (p = 0.02), and traumatic subarachnoid hemorrhage (p = 0.05) as independent predictors of mortality.

Conclusion

The GCS-P is a useful predictor of 30-day mortality, although its usefulness for other clinical outcomes remains to be proven.

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Authors and Affiliations

  1. Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, M6 8HD, UK

    Helen Maye, Mueez Waqar & Francesca Colombo

  2. Department of Neurosurgery, Royal Preston Hospital, Preston, UK

    Elvira Lekka

Authors
  1. Helen Maye
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  2. Mueez Waqar
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  3. Francesca Colombo
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  4. Elvira Lekka
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Corresponding author

Correspondence to Helen Maye.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Competing interests

The authors declare no competing interests.

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This article is part of the Topical Collection on Brain trauma

Previous Presentations: Poster Presentation at SBNS, Virtual Meeting, UK April 2021

Appendices

Appendix 1

See Table 4

Table 4 Discharge destination analysis
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Appendix 2

See Table 5

Table 5 Survival analysis
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Maye, H., Waqar, M., Colombo, F. et al. External validation of the GCS-Pupils Score as an outcome predictor after traumatic brain injury in adults: a single-center experience. Acta Neurochir 165, 289–297 (2023). https://doi.org/10.1007/s00701-022-05431-3

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  • DOI: https://doi.org/10.1007/s00701-022-05431-3

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