Validation of a Practical Method for Estimating Total Glasgow Coma Scale Scores in Intubated Traumatic Brain Injury Patients: A Cohort Study Using the MIMIC-IV Database.

AIMS AND

OBJECTIVES

To validate a practical method for estimating total Glasgow Coma Scale (etGCS) scores in intubated traumatic brain injury (TBI) patients and evaluate its reliability when integrated into established ICU severity scoring systems.

BACKGROUND

TBI is a global health issue, often leading to high mortality and disability. The Glasgow Coma Scale (GCS), essential for assessing TBI severity, is less reliable in intubated patients due to the inability to assess verbal responses.

DESIGN

Retrospective cohort study.

METHODS

Data were extracted from the MIMIC-IV database. The reliability of the etGCS was evaluated through its association with in-hospital mortality and its performance when integrated into established ICU severity scoring systems. Multiple statistical approaches were used to validate the findings.

RESULTS

Among 886 intubated TBI patients, the etGCS showed consistent reliability in predicting in-hospital mortality (AUC: 68.22%, 95% CI: 64.29%-72.14%). When combined with pupillary assessment (etGCS-P), the predictive performance remained stable (AUC: 71.99%, 95% CI: 67.89%-76.08%). Furthermore, the estimation method demonstrated reliable performance when integrated into established severity scoring systems. The removal of etGCS from these systems resulted in decreased predictive performance, confirming its valuable contribution to mortality prediction.

CONCLUSIONS

This study validated a practical and reliable method for estimating total GCS scores in intubated TBI patients. The estimated scores showed consistent predictive value and enhanced existing severity scoring systems, supporting its clinical utility in ICU settings.

RELEVANCE TO CLINICAL PRACTICE: This validation of a practical GCS estimation method supports nurses in delivering accurate patient assessments, facilitating clinical communication and making informed care decisions for intubated TBI patients.

NO PATIENT OR PUBLIC CONTRIBUTION: This retrospective study involved no patient or public participation in the design or conduct.