Artikel
A comparison between Helsinki score and Glasgow coma score in predicting clinical outcome in patients with traumatic brain injury
Vergleich zwischen Helsinki score and Glasgow Coma Score bei der Berechnung des klinischen Outcomes bei Patienten mit Schädel-Hirn-Trauma
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Autoren
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Fares Komboz
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Hiba Douja Chehade
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Tammam Abboud
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Traumatic brain injury (TBI) is a major source of death and disability worldwide. Accurate assessment and outcome prediction is of utmost importance for triaging and guiding appropriate therapeutic decision-making process in affected patients. Glasgow coma score (GCS) is considered the most important prediction tool in TBI. However, GCS does not take primary imaging results into consideration. The Helsinki score was developed recently to radiologically predict clinical outcome in patients with TBI. The aim of this study was to study the prediction performance of the Helsinki score in comparison to GCS in a large cohort of patients with TBI.
Methods: Patients who were treated at our hospital between 2008 to 2019 and had a TBI with an initial GCS of 14 or less were included. In addition to GCS at admission, we calculated the Helsinki score based on primary computed tomography (CT) imaging. The score depends on the lesion type, lesion size, presence of intraventricular hemorrhage, and degree of compression of suprasellar cisterns, with a score varying between -3 and 14. Outcome measures were Glasgow outcome score (GOS) and mortality at hospital discharge. We then calculated the Kendall tau-b correlation coefficient of each predictor with each of the outcome measures.
Results: 544 patients were included, with mean age of 62.2 ±21.5 years. The median GCS in the emergency room was 14, IQR=12, median Helsinki was 3, IQR=3. At the time of discharge, mortality rate was of 8.6%. The median GOS at discharge was 4 ±1.
The Helsinki score significantly correlated with each of the recorded outcome measures, i.e., with mortality (p = 2.37e-10) and GOS (p = 7.86e-30), as GCS did with mortality (p = 0.004) and GOS (p = 8.33e-20). Helsinki score correlated with mortality significantly higher than GCS (τb = 0.36 vs τb = -0.11, respectively) and with GOS (τb = -0.40 vs τb = 0.33, respectively) at discharge.
Conclusion: Our results show that taking only radiological findings into account can already lead to superior outcome prediction than that of the gold-standard GCS. However, scoring systems like the Helsinki, albeit being versatile, lack the clinical assessment, which remains of crucial importance in the decision-making process while treating TBI patients. This underlines the need to apply comprehensive testing systems which takes both radiological and clinical parameters into account.
