Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2013

01-02-2013 | Original Article

The prognostic reliability of the Glasgow coma score in traumatic brain injuries: evaluation of MRI data

Authors: D. Woischneck, R. Firsching, B. Schmitz, T. Kapapa

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2013

Login to get access

Abstract

Purpose

To clarify the predictive power of the Glasgow coma score (GCS) after traumatic brain injury (TBI) and in the context of brain stem lesions.

Methods

In 143 patients who had suffered severe TBI, the GCS was correlated to brain damage as visualized by cranial magnetic resonance imaging (MRI). This technique evaluates the damage to the brain stem in particular. The Brussels coma score (BCS) was also used.

Results

The GCS was not significantly correlated to brain stem lesions when it was only scored at the time of admission. When MRI was not used later on, the GCS showed a poor ability to predict the outcome. After 24 h, and on the day of MRI screening, the GCS was significantly correlated with two parameters: outcome (the higher the GCS, the better the outcome) and the frequency of patients without injuries to the brainstem in MRI (the higher the GCS, the higher this frequency). These correlations were much more evident when the BCS was used. The prognostic power of the GCS was found to vary over time; for example: a GCS of 3 at admission was associated with a favorable prognosis; a GCS of 4 signified a poor prognosis, irrespective of the time point at which the GCS was scored; and the prognostic power of a GCS of 5 deteriorated from the day of the MRI onwards, whereas the prognostic power of a GCS of 6 or 7 varied little over time.

Conclusions

We only recommend the use of the GCS for prognostic evaluation in a multidimensional model. Study protocols should contain additional brain stem function parameters (BCS, pupil condition, MRI).
Literature
1.
2.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.PubMedCrossRef
3.
Chamoun RB, Robertson CS, Gopinath SP. Outcome in patients with blunt head trauma and a Glasgow coma scale score of 3 at presentation. J Neurosurg. 2009;111(4):683–7.PubMedCrossRef
4.
5.
Woischneck D, Firsching R, Ruckert N, Hussein S, Heissler H, Aumuller E, et al. Clinical predictors of the psychosocial long-term outcome after brain injury. Neurol Res. 1997;19(3):305–10.PubMed
6.
Chaudhuri K, Malham GM, Rosenfeld JV. Survival of trauma patients with coma and bilateral fixed dilated pupils. Injury. 2009;40(1):28–32.PubMedCrossRef
7.
Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D. Glasgow coma scale score, mortality, and functional outcome in head-injured patients. J Trauma. 2004;56(5):1084–9.PubMedCrossRef
8.
Firsching R, Woischneck D, Klein S, Ludwig K, Dohring W. Brain stem lesions after head injury. Neurol Res. 2002;24(2):145–6.PubMedCrossRef
9.
Weiss N, Galanaud D, Carpentier A, Naccache L, Puybasset L. Clinical review: prognostic value of magnetic resonance imaging in acute brain injury and coma. Crit Care. 2007;11(5):230.PubMedCrossRef
10.
Weiss N, Galanaud D, Carpentier A, Tezenas de Montcel S, Naccache L, Coriat P, et al. A combined clinical and MRI approach for outcome assessment of traumatic head injured comatose patients. J Neurol. 2008;255(2):217–23.PubMedCrossRef
11.
Brihaye J, Frowein RA, Lindgren S. Report on the meeting of the WFNS Neuro-traumatology Committee. Brussels I coma scaling. Acta Neurochir (Wien). 1976;40:181–6.
12.
Frowein RA. Classification of coma. Acta Neurochir (Wien). 1976;34(1–4):5–10.CrossRef
13.
Teasdale G, Gentleman D. The description of “conscious level”: a case for the Glasgow coma scale. Scott Med J. 1982;27(1):7–9.
14.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.PubMedCrossRef
15.
Firsching R, Woischneck D, Klein S, Reissberg S, Dohring W, Peters B. Classification of severe head injury based on magnetic resonance imaging. Acta Neurochir (Wien). 2001;143(3):263–71.CrossRef
16.
Woischneck D, Kapapa T, Heissler HE, Reissberg S, Skalej M, Firsching R. Respiratory function after lesions in medulla oblongata. Neurol Res. 2009;31(10):1019–22.PubMedCrossRef
17.
Carpentier A, Galanaud D, Puybasset L, Muller JC, Lescot T, Boch AL, et al. Early morphologic and spectroscopic magnetic resonance in severe traumatic brain injuries can detect “invisible brain stem damage” and predict “vegetative states”. J Neurotrauma. 2006;23(5):674–85.PubMedCrossRef
18.
Mannion RJ, Cross J, Bradley P, Coles JP, Chatfield D, Carpenter A, et al. Mechanism-based MRI classification of traumatic brainstem injury and its relationship to outcome. J Neurotrauma. 2007;24(1):128–35.PubMedCrossRef
19.
Shibata Y, Matsumura A, Meguro K, Narushima K. Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage. Clin Neurol Neurosurg. 2000;102(3):124–8.PubMedCrossRef
20.
Galloway NR, Tong KA, Ashwal S, Oyoyo U, Obenaus A. Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma. 2008;25(10):1153–62.PubMedCrossRef
21.
Poon WS, Zhu XL, Ng SC, Wong GK. Predicting one year clinical outcome in traumatic brain injury (TBI) at the beginning of rehabilitation. Acta Neurochir Suppl. 2005;93:207–8.PubMedCrossRef
22.
Toschlog EA, MacElligot J, Sagraves SG, Schenarts PJ, Bard, Goettler CE, et al. The relationship of injury severity score and Glasgow coma score to rehabilitative potential in patients suffering traumatic brain injury. Am Surg. 2003;69(6):491–7. discussion 7–8.PubMed
23.
Matsushita M, Hosoda K, Naitoh Y, Yamashita H, Kohmura E. Utility of diffusion tensor imaging in the acute stage of mild to moderate traumatic brain injury for detecting white matter lesions and predicting long-term cognitive function in adults. J Neurosurg. 2011;115(1):130–9.PubMedCrossRef
24.
Perlbarg V, Puybasset L, Tollard E, Lehericy S, Benali H, Galanaud D. Relation between brain lesion location and clinical outcome in patients with severe traumatic brain injury: a diffusion tensor imaging study using voxel-based approaches. Hum Brain Mapp. 2009;30(12):3924–33.PubMedCrossRef
25.
Xu J, Rasmussen IA, Lagopoulos J, Haberg A. Diffuse axonal injury in severe traumatic brain injury visualized using high-resolution diffusion tensor imaging. J Neurotrauma. 2007;24(5):753–65.PubMedCrossRef
26.
Calvi MR, Beretta L, Dell’Acqua A, Anzalone N, Licini G, Gemma M. Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions. J Trauma. 2011;70(2):447–51.PubMedCrossRef
Metadata
Title
The prognostic reliability of the Glasgow coma score in traumatic brain injuries: evaluation of MRI data
Authors
D. Woischneck
R. Firsching
B. Schmitz
T. Kapapa
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2013
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0240-8

Other articles of this Issue 1/2013

European Journal of Trauma and Emergency Surgery 1/2013 Go to the issue

Original Article

Reamed intramedullary nailing of diaphyseal tibial fractures: comparison of compression and non-compression nailing

Original Article

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Original Article

Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists

Original Article

A practical therapeutic protocol for cervical tuberculosis

Original Article

Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

Review Article

Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk