• Yu-Chun Chien, Wen-Chu Chiang, Chi-Hsin Chen, Jen-Tang Sun, Sabariah Faizah Jamaluddin, Hideharu Tanaka, Matthew Huei-Ming Ma, Edward Pei-Chuan Huang, Mau-Roung Lin, and PATOS Clinical Research Network.
• Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
• Eur J Emerg Med. 2024 Jun 1; 31 (3): 181187181-187.

Background And ImportanceThis study compared the on-scene Glasgow Coma Scale (GCS) and the GCS-motor (GCS-M) for predictive accuracy of mortality and severe disability using a large, multicenter population of trauma patients in Asian countries.ObjectiveTo compare the ability of the prehospital GCS and GCS-M to predict 30-day mortality and severe disability in trauma patients.DesignWe used the Pan-Asia Trauma Outcomes Study registry to enroll all trauma patients >18 years of age who presented to hospitals via emergency medical services from 1 January 2016 to November 30, 2018.Settings And ParticipantsA total of 16,218 patients were included in the analysis of 30-day mortality and 11 653 patients in the analysis of functional outcomes.Outcome Measures And AnalysisThe primary outcome was 30-day mortality after injury, and the secondary outcome was severe disability at discharge defined as a Modified Rankin Scale (MRS) score ≥4. Areas under the receiver operating characteristic curve (AUROCs) were compared between GCS and GCS-M for these outcomes. Patients with and without traumatic brain injury (TBI) were analyzed separately. The predictive discrimination ability of logistic regression models for outcomes (30-day mortality and MRS) between GCS and GCS-M is illustrated using AUROCs.Main ResultsThe primary outcome for 30-day mortality was 1.04% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.917 (0.887-0.946) vs. GCS-M:0.907 (0.875-0.938), P  = 0.155. The secondary outcome for poor functional outcome (MRS ≥ 4) was 12.4% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.617 (0.597-0.637) vs. GCS-M: 0.613 (0.593-0.633), P  = 0.616. The subgroup analyses of patients with and without TBI demonstrated consistent discrimination ability between the GCS and GCS-M. The AUROC values of the GCS vs. GCS-M models for 30-day mortality and poor functional outcome were 0.92 (0.821-1.0) vs. 0.92 (0.824-1.0) ( P  = 0.64) and 0.75 (0.72-0.78) vs. 0.74 (0.717-0.758) ( P  = 0.21), respectively.ConclusionIn the prehospital setting, on-scene GCS-M was comparable to GCS in predicting 30-day mortality and poor functional outcomes among patients with trauma, whether or not there was a TBI.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

29 keywords...

hide…