Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study

  • Abdelrady S. Ibrahim
  • Mohamed G. Aly
  • Khaled A. Abdel-Rahman
  • Mona A. Mohamed
  • Mogedda M. Mehany
  • Eman M. Aziz
Original Article



Between 25 and 40% of extubated patients with traumatic brain injury (TBI) in the intensive care unit at our hospital (Assiut University Hospital–Assiut–Egypt) require reintubation. This reflects the importance of developing better criteria for predicting successful extubation in TBI. We evaluated the accuracy of semi-quantitative cough strength score (SCSS) and Glasgow coma scale (GCS) in predicting extubation outcomes in TBI.


This prospective observational study included patients (18–65 years), with TBI on mechanical ventilation more than 24 h who were ready to be weaned off. Three tools were used. Tool I: Patient assessment sheet, this tool used to assess socio-demographic and clinical data of patients. Tool II: Semi-quantitative cough strength score (0–5). Tool III: Factors affecting successful extubation, this tool used to confirm the presence or absence of factors that can interfere with the results of extubation outcomes. After extubation, patient was followed up for 72 h to check for extubation success. Multivariate logistic binary regression test was used to calculate odds ratio for different clinical data collected before extubation as independent factors and successful extubation as a dependent factor.


Among 80 patients of mean age 40.6 (± 16.1), 34% were female, median admission GCS was 8 (4–13), extubation occurred on mean post-injury day 6.5 (± 4), and 46.3% required reintubation. Successfully extubated patients had higher semi-quantitative cough scores and GCS. 81.3% patients with SCSS 5 were successfully extubated, while all patients with SCSS 0 were reintubated. All patients with GCS 15 were successfully extubated, and all patients with GCS < 12 required intubation.


SCSS has shown promise in predicting successful extubation in TBI.


Semi-quantitative cough strength score Mechanical ventilation Extubation Traumatic brain injury 



The study was funded by departmental resources.

Compliance with Ethical Standards

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical Approval

The study was approved by our local institutional review board (IRB), Faculty of medicine, ethical committee, Assiut University, Assiut, Egypt. Approval date: May 4 2016. Organization’s Unique Protocol ID: 17100390.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Abdelrady S. Ibrahim
    • 1
  • Mohamed G. Aly
    • 1
  • Khaled A. Abdel-Rahman
    • 1
  • Mona A. Mohamed
    • 2
  • Mogedda M. Mehany
    • 2
  • Eman M. Aziz
    • 2
  1. 1.Anaesthesia and ICU Department, Faculty of MedicineAssiut University HospitalAssiut CityEgypt
  2. 2.Critical Care and Emergency Nursing Department, Faculty of NursingAssiut UniversityAssiutEgypt

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