Validation of the GCS-Pupil scale in Traumatic Brain Injury Incremental prognostic performance of pupillary reactivity with GCS in the prospective observational cohorts CENTER-TBI and TRACK-TBI
Year: 2024
Type: preprint
Abstract: Objective To compare the incremental prognostic value of pupillary reactivity as captured in the GCS-Pupils score (GCS-P) or added as separate variable to the Glasgow Coma Scale (GCS) in traumatic brain injury (TBI). Methods We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n=3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n=1439) cohorts. We used logistic regression to quantify the prognostic performances of GCS-P versus GCS according to Nagelkerke’s R 2 . Endpoints were mortality and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-4) at 6 months after injury. We estimated 95% confidence intervals with bootstrap resampling to summarize the improvement in prognostic capability. Results GCS as a linear score had a R 2 of 24% (95% confidence interval [CI] 17-30) and 30% (95%CI 17-43) for mortality and 29% (95%CI 25-34) and 38% (95%CI 29-47) for unfavorable outcome in CENTER-TBI and TRACK-TBI respectively. In the meta-analysis, pupillary reactivity as a separate variable improved the R 2 by an absolute value of 6% and 2% for mortality and unfavorable outcome (95%CI 4.0-7.7 and 1.2-3.0, respectively), with half the improvement captured in the GCS-P score (3%, 95%CI 2.1-3.3 and 1%, 95%CI 1-1.7, respectively). Conclusions GCS-P has a stronger association with outcome after TBI than the GCS alone. However, for prognostic models, inclusion of GCS and pupillary reactivity as separate scores is preferable.
Source: medRxiv
Institutions: Leiden University Medical Center, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, University of California, San Francisco, University of Edinburgh, University of California San Diego, University of Antwerp, Antwerp University Hospital, University of Cambridge, Addenbrooke's Hospital
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Capital Medical University, University of Waterloo, University of Cape Town, National Institutes of Health, Centers for Disease Control and Prevention, University of California, Los Angeles, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Combat Casualty Care Research Program, National Institute of Neurological Disorders and Stroke
OpenAlex ID: W4399379598