Glasgow Coma Scale의 임상적 의의 : The First Ten Years

Teasdale, Graham,박춘근 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

Since Teasdale and Jennet published a method that had been evolved in Glasgow for assessing the so-called "conscious level" in 1974, the method has undergone extensive evaluation, has been adapted widely and has come to be known as the "Glasgow Coma Scale". However some investigators raised a question about interpretation of the scale in argument, particularly in terms of analysis of prognosis. It may be indispensable for clinicians and investigators to come to an agreement in interpretation of each other's investigational result with the same idea about "Glasgow Coma Scale". So the authors now review some of the factors that contributed to the desgn of the scale, how it has withstood the test of both scientific study and practical usage, and also to set into context its offspring, the "Glasgow Coma Score".

심폐소생술 이후 발생한 저산소허혈뇌병증 환자에서 신경학적 예후에 대한 예측인자

윤영신,김원섭,신지수,정은혜,양혜란,최경규,박기덕,이향운 대한신경과학회 2010 대한신경과학회지 Vol.28 No.3

Background: Cardiopulmonary resuscitation (CPR) can lead to various neurologic outcomes in patients with hypoxic-ischemic encephalopathy (HIE). This study investigated the usefulness of clinical markers and electroencephalography (EEG) in predicting the neurologic prognosis of HIE after CPR. Methods: We reviewed the clinical findings of 51 patients with HIE, including the medical history, the duration from the onset of symptoms to the recovery of spontaneous circulation, Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scores, and presence of seizure or status epilepticus. Patients were divided into three outcomes groups: death, persistent vegetative state, and recovering alertness and awareness. Digital EEG and visual and quantitative analyses were performed in each patient. For quantitative EEG (qEEG) analysis, we defined and compared the distance in the spatial band-power patterns and phase coherence patterns between healthy normal subjects and each patient. Results: Patients with HIE showed a high mortality rate (54.9%, 28/51), and their neurologic prognosis was significantly related to the initial GCS and FOUR scores. In the qEEG analysis, patients’ groups showed a prominent delta frequency band, and the healthy normal group presented a marked alpha predominance. As the severity decreased, the similarity in the spatial band-power pattern and functional connectivity pattern between normal subjects and patients increased. Conclusions: Low initial GCS and FOUR scores could be predictive of a poor neurologic prognosis in patients with HIE,and qEEG analysis might be a useful predictor of their neurologic outcomes.

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India

Agrawal Nishant,Iyer Shivakumar S,Patil Vishwanath,Kulkarni Sampada,Shah Jignesh N,Jedge Prashant 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.2

Background This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. Results In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. Conclusions The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

중증 외상에서 Glasgow Coma Scale(GCS) 운동반응의 의의

신중호 ( Jung Ho Shin ),이성우 ( Sung Woo Lee ),정인철 ( In Chul Jung ),김수진 ( Su Jin Kim ),이베안 ( Be An Lee ),문성우 ( Sung Woo Moon ),정상헌 ( Sang Hun Jung ),김낙훈 ( Nak Hoon Kim ),최성혁 ( Sung Hyuk Choi ),홍윤식 ( Yun Si 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: Severely injured patients need an optimal triage system that can differentiate those patients who require the resources of the trauma center from those who do not. American national guidelines recommend that patients with Glasgow Coma Scale (GCS) scores less than 14 or triaged-Revised Trauma Score (t-RTS) less than 11 should be triaged to trauma centers. Although, in many studies, the GCS score has been shown to be the strongest single prognostic predictor in trauma patients, the presence of unmeasurable components of the GCS limits its usefulness. Also, it is difficult for emergency medical technicians to estimate the GCS in a prehospital setting because of its complexity and the shortage of time. This study was designed to evaluate the efficacy of the motor component of the GCS in severely injured patients. We hypothesized that the motor component of the GCS (GCSM) would be equally sensitive as the total GCS in triage of severely injuried patients. Methods: We reviewed a total of 114 patient who visited the Emergency Center of Korea University Ansan Hospital between December 2001 and September 2002. Of those 114 patients, 36 were excluded because of inadequate medical records or visiting after cardiac arrest. The parameters that we used as tools for analysi, were age, sex, GCS score, RTS, Injury Severity Score (ISS), actual survival rate (As), and probable survival rate (Ps). We defined severely injured patients (t-RTS ≤11) requiring care in a trauma center or intensive care unit. Based on American College of Surgeons Committee on Trauma (ACSCOT) guidelines, we defined GCS ≤13 as positive triage by GCS, ISS ≥16 as positive triage by ISS, and GCSM ≤5 as positive triage by the motor component of GCS. The sensitivity and the specificity were calculated, and a statistical analysis by t-test was conducted with two-tail α levels of 0.05. Results: Of the 78 patients, the mean age was 44.7±2.2,and the mean ISS was 21.7±1.0. The GCSM was found to have a sensitivity of 85.7% and a specificity of 98.0% for t-RTS≤11. The GCS had a sensitivity of 89.3% and a specificity of 90.0% (p = not significant). Conclusion: Our results indicate that the motor component of GCS is a sensitive predictor of patients` poor prognosis and that the GCSM is equivalent to the GCS for prehospital triage. In view of the simplicity of the GCSM, its substitution for the GCS in triage systems might lead to a higher use rate among prehospital healthcare providers.

Risk factors for mortality of severe trauma based on 3 years` data at a single Korean institution

Joohyun Sim,Jaeheon Lee,John Cook-Jong Lee,Yunjung Heo,Heejung Wang,Kyoungwon Jung 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.4

Purpose: This study aimed to determine the mortality rate in patients with severe trauma and the risk factors for trauma mortality based on 3 years’ data in a regional trauma center in Korea. Methods: We reviewed the medical records of severe trauma patients admitted to Ajou University Hospital with an Injury Severity Score (ISS) > 15 between January 2010 and December 2012. Pearson chi-square tests and Student t-tests were conducted to examine the differences between the survived and deceased groups. To identify factors associated with mortality after severe trauma, multivariate logistic regression was performed. Results: There were 915 (743 survived and 172 deceased) enrolled patients with overall mortality of 18.8%. Age, blunt trauma, systolic blood pressure (SBP) at admission, Glasgow Coma Scale (GCS) at admission, head or neck Abbreviated Injury Scale (AIS) score, and ISS were significantly different between the groups. Age by point increase (odds ratio [OR], 1.016; P = 0.001), SBP ≤ 90 mmHg (OR, 2.570; P < 0.001), GCS score ≤ 8 (OR, 6.229; P < 0.001), head or neck AIS score ≥ 4 (OR, 1.912; P = 0.003), and ISS by point increase (OR, 1.042; P < 0.001) were significant risk factors. Conclusion: In severe trauma patients, age, initial SBP, GCS score, head or neck AIS score, and ISS were associated with mortality.

외상환자 중증도 분류에 있어 병원전단계와 병원단계의 RTS (Revised trauma score) 비교

이승엽 ( Seung Yeop Lee ),전영진 ( Young Jin Cheon ),한철 ( Chul Han ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. Methods: We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. Results: There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. Conclusion: Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients. [ J Trauma Inj 2015; 28: 177-181 ]

급성기 두부손상에서 Creatine Kinase-BB (CK-BB)의 임상적 의의

김헌주,홍순기,허철,한용표 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.4

Serial enzymatic determinations by electrophoresis were confined in serum of CK-BB (creatine kinase brain fraction), which were performed on 150 patients with acute head injury. The purpose of this study was to re-evaluate the usefulness of this serum enzyme value as a prognostic correlates. The results obtained are as follows : 1) 125 cases (83.3%) among 150 cases with head injury were revealed as CK-BB positive finding, whereas 25 cases (16.7%) with negative results have generally good outcome. 2) 3 cases (11.5%) of false positive finding were shown among 26 control group with back pain. 3) The maximum value of CK-BB(CK-BBmax) was seen within 1st day(38.4%), and 3rd days (80.8%) following injury. 4) The appearance of mean CK-BBmax had two varieties of peak incidence on 1st-and 4th day following injury. 5) The Glasgow Coma Scale(GCS) Score on admission had close relationship to the value of inital CK-BB(CK-BBin) and CK-BBmax respectively (P<0.001) 6) The ratio of mean value between CK-BBin and CK-BBmax had statistical significance in cases of skull fracture and contusional and/or intracerebral hemorrhage, respectively (P<0.05. p<0.001). 7) The significant correlation of mean CK-BBin(≥1 IU/L) to outcome (P<0.003) was shown, whereas mean CK-BBmax(≥1 IU/L) to outcome did not (P= 0.126). 8) The Glasgow Outcome Scale (GOS) was strongly correlated to mean GCS Score (P<0.000) and mean CK-BBin (P<0.000). but not to mean CK-BBmax (P<0.139). 9) The correlationship between mean value of CK-BBin and CK-BBmax was statistically significant only in good recovery and moderate disability group, respectively (P<0.000 & P<0.003).

The Prognostic Factors Related to Traumatic Brain Stem Injury

Kim, Hun-Joo The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.1

Objective : This study was conducted to assess the clinical significance of traumatic brain stem injury (TBSI) reflected on Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) by various clinical variables. Methods : A total of 136 TBSI patients were selected out of 2695 head-injured patients. All initial computerized tomography and/or magnetic resonance imaging studies were retrospectively analyzed according to demographic- and injury variables which result in GCS and GOS. Results : In univariate analysis, mode of injury showed a significant effect on combined injury (p<0.001), as were the cases with skull fracture on radiologic finding (p<0.000). The GCS showed a various correlation with radiologic finding (p<0.000), mode of injury (p<0.002), but less favorably with impact site (p<0.052), age (p<0.054) and skull fracture (p<0.057), in order of statistical significances. However, only GOS showed a definite correlation to radiologic finding (p<0.000). In multivariate analysis, the individual variables to enhance an unfavorable effect on GCS were radiologic finding [odds ratio (OR) 7.327, 95% confidence interval (CI)], mode of injury (OR; 4.499, 95% CI) and age (OR; 3.141, 95% CI). Those which influence an unfavorable effect on GOS were radiologic finding (OR; 25.420, 95% CI) and age (OR; 2.674, 95% CI). Conclusion : In evaluation of TBSI on outcome, the variables such as radiological finding, mode of injury, and age were revealed as three important ones to have an unfavorable effect on early stage outcome expressed as GCS. However, mode of injury was shown not to have an unfavorable effect on late stage outcome as GOS. Among all unfavorable variables, radiological finding was confirmed as the only powerful prognostic variable both on GCS and GOS.

Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients

Se, Young-Bem,Chun, Hyoung-Joon,Yi, Hyeong-Joong,Kim, Dong-Won,Ko, Yong,Oh, Suck-Jun The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.2

Objective: This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU). Methods: This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods. Results: A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3% of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection. Conclusion: When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.

두부외상 연속 1,000례의 임상적 고찰

김원호,이경석,배학근,윤일규,이인수 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.2

A series of 1000 consecutive head injuries was presented. Traffic accident was the major cause of head injury(77.1%). Unlikely to the other reports in Korea, 1) passenger's traffic accident was slightly more common than pedestrian traffic accident, 2) traffic accidents related to motorcycles and bicycles were more common, and 3) traffic accident to the tractor shared 3.2% of the traffic accident. Transportation of the patients was not delayed in this medium sized city. Glasgow coma score on arrival was 3-8 in 15.4%, 9-12 in 11.2%, and 13-15 in 73.4%. Cranial vault fracture was observed in 31.6%. The presence of vault fracture was closely related to the rate of operation and the mortality. CT brain scan was performed in 720 patients. Abnormal findings were observed 365 patients(50.7%), including 233 cases of mass lesions and 101 cases of diffuse lesions. Epidural hemotoma was the most common mass lesion. The rate of operation was 14.9%, and the operative mortality was 30.6%. Outcome at discharge was good recovery 729, moderate disadility 78, severe disability 21, vegetative state 3, and death 96. There were 73 cases who were self-discharged or transferred to other hospitals. Overall case fatality rate was 10.4%.