The prediction value of Glasgow coma scale-pupils score in neurocritical patients: a retrospective study

ABSTRACT

Background

External validation is necessary before  its clinical recommendation in new setting. The aim is to externally validate Glasgow Coma Scale-pupils score (GCS-P) in neurocritical patients and to compare its performances with Glasgow Coma Scale (GCS) and its derivatives.

Methods

GCS-P at admission was calculated for individual based on the model developed by Brennan et al. Area under the receiver operating characteristic curves (AUCs), Nagelkerke’s R² and Brier scores were used to assess external validity of GCS-P to predict mortality in neurocritical patients and to compare predictive performance with GCS and its derivatives.

Subjects

4372 neurocritical patients from intensive care units of Beth Israel Deaconess Medical Center, United States between 2001 and 2012.

Results

GCS-P showed good discrimination (AUC 0.847 for in-hospital mortality and 0.774 for ninety-day mortality), modest calibration (Nagelkerke’s R2 33.1% for in-hospital mortality and 23.3% for ninety-day mortality). Predictive performances of GCS and its derivatives was inferior to GCS-P.

Conclusions

GCP-P discriminated well in between death in neurocritical patients. GCP-P improved predictive performance for short-term mortality over GCS and its derivatives in neurocritical patients. It would be a simple, early and reasonable daily routine option for prognosis assessment in neurocritical setting.

KEYWORDS:

• Glasgow Coma Scale score
• Glasgow Coma Scale-pupils score
• intensive care unit
• prognosis
• pupil reactivity

List of abbreviations

GCS, Glasgow coma scale

GCS-P, Glasgow Coma Scale-pupils

GCS-M, motor component Glasgow Coma Scale

TBI, Traumatic brain injury

MIMIC, Medical Information Mart for Intensive Care

ICU, intensive care units

PRS, Pupil reactivity score

CVD, Ischemic cerebral vascular disease

ROC, receiver operating characteristic curve

AUC, area under the curve

IDI, Integrated discrimination improvement

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Shenzhen Municipal Health Commission [SZXJ2017024]; Sanming Project of Medicine in Shenzhen .