Artikel
The prognostic reliability of the Glasgow coma score, evaluated on the basis of MRI examination
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Autoren
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Dieter Woischneck
- Neurochirurgische Klinik, Klinikum Landshut, Deutschland
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Thomas Kapapa
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
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Raimund Firsching
- Neurochirurgische Klinik, Universitätsklinikum Magdeburg, Deutschland
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: The study objective is the investigation of the following hypothesis in patients following traumatic brain injury (TBI): The Glasgow Coma Score (GCS) has predictive potency, provided it is correlated to the extent of the brain stem lesion.
Methods: In 143 patients aged between 18 and 65 years who had suffered serious TBI, the GCS was correlated to the extent of the brain damage which could be visualised by cranial magnetic resonance imaging (MRI). The extent of the brain damage was ascertained using MRI classification, which evaluates the damage to the brain stem. The Brussels Coma Score (BCS) was taken as a comparison, since it is regarded to be sensitive to brain stem lesions.
Results: The GCS upon hospital admission was not significantly correlated to the occurrence of brain stem lesions. It had no predictive potency for the treatment outcome. After 24 hours and on the day of MRI screening (mean: 3.2 days post trauma), the GCS was found to be significantly dependent on both parameters: the higher the GCS, the better the treatment outcome and the less pronounced the brain stem damage. In the case of the BCS, which also takes the condition of the pupils into account, these correlations were much more evident. The prognostic potency of the GCS scores was dependent on progress over time: GCS 4 signified a poor prognosis irrespective of time. GCS 3 on admission was related to a more favourable prognosis, but over time with a less favourable one, whereby the two later timepoints did not differ. The prognostic relevance of GCS 5 deteriorated only from the day of MRI onwards, and that of 6 and 7 varied little over the course. The patients with GCS 8 and GCS > 8 differed primarily at the latest examination. The extent of the brain stem lesion revealed similar relationships to the GCS over time.
Conclusions: We recommend use of the GCS for prognostic evaluation only in a multidimensional model: the predictive possibilities of individual scores are very varied, and the course over time is to be considered in addition. The study protocols should, in addition to the GCS, contain further parameters of brain stem function (BCS, pupil condition), and MRI screening itself can also be employed.
