• Jesús Abelardo Barea-Mendoza, Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Manuel Quintana-Díaz, Lluís Serviá-Goixart, Francisco Guerrero-López, Javier González-Robledo, Ismael Molina-Díaz, Juncal Sánchez Arguiano, Mario Chico-Fernández, and Grupo de Trabajo de Neurointensivismo y Trauma de la SEMICYUC.
• UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
• Emergencias. 2023 Feb 1; 35 (1): 394339-43.

ObjectivesTo compare the ability of the Glasgow Coma Scale (GCS) score, the GCS Pupils (GCS-P) score, and the Pupil Reactivity Score (PRS) to predict mortality in patients with severe head injury.Material And MethodsRetrospective analysis of all patients with severe head injury and initial GCS scores of 8 or lower on initial evaluation for whom records included pupil dilation information and clinical course after admission to intensive care units of participating hospitals. We assessed the ability of each of the 3 scores (GCS, GCS-P, and PRS) to predict mortality using discrimination analysis. Discrimination was estimated by calculating the areas under the receiver operating characteristic curves (AUC) and 95% CIs.ResultsA total of 1551 patients with severe head injury and pupil dilation records were studied. The mean age was 50 years, 1190 (76.7%) were males, and 592 (38.2%) died. No pupil dilation was observed in 905 patients (58.3%), 362 (23.3%) had unilateral mydriasis, and 284 (18.3%) had bilateral mydriasis. The GCS-P score was significantly better at predicting mortality, with an AUC of 0.77 (95% CI, 0.74-0.79), versus 0.69 (95% CI, 0.67-0.72) for the GCS, and 0.75 (95% CI, 0.72-0.77) for the PRS. As the GCS-P score decreased, mortality increased.ConclusionThe GCS-P was more useful than the GCS for predicting death after severe head injury.

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