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.
Yangchun Zhang, Feng Chen, Na Ma, Cairong Liu, Hengchang Cao, Xufeng Chen, Xueli Ji
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Abstract
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.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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