Assessment of patients with traumatic brain injury using Glasgow coma scale (GCS) in Civil hospital Karachi
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale). GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first responders, EMS, nurses, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care. The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow’s Institute of Neurological Sciences at the city’s Southern General Hospital. GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system, as it was designed for. The initial indication for use of the GCS was serial assessments of patients with traumatic brain injury.1 The scale is composed of three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).
Eye response (E)
There are four grades starting with the most severe:
1.No opening of the eye
2.Eye opening in response to pain stimulus.
3.Eye opening to speech.
4.Eyes opening spontaneously.
Verbal response (V)
There are five grades starting with the most severe:
1.No verbal response
2.Incomprehensible sound.
3.Inappropriate words.
4.Confused.
5.Oriented.
Motor response (M)
There are six grades:
1.No motor response
2.Decerebrate posturing accentuated by pain.
3.Decorticate posturing accentuated by pain.
4. Withdrawal from pain.
5. Localizes to pain.
6. Obeys commands.
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The GCS is in use by neurosurgeons and other disciplines in more than 80 countries worldwide and has been translated into the national language in 74%.2
TBI is a leading cause of death and disability around the globe.3and presents a major worldwide social, economic, and health problem.4 It is the number one cause of coma,5 it plays the leading role in disability due to trauma,6 and is the leading cause of brain damage in children and young adults. 7In Europe it is responsible for more years of disability than any other cause.8 It also plays a significant role in half of trauma deaths.9 Findings on the frequency of each level of severity vary based on the definitions and methods used in studies. A World Health Organization study estimated that between 70 and 90% of head injuries that receive treatment are mild,10 and a US study found that moderate and severe injuries each account for 10% of TBIs, with the rest mild.11 The annual incidence of mild TBI is difficult to determine but may be 100–600 people per 100,000.12 The incidence of TBI is increasing globally, due largely to an increase in motor vehicle use in low- and middle-income countries.13 In developing countries, automobile use has increased faster than safety infrastructure could be introduced.14 In contrast, vehicle safety laws have decreased rates of TBI in high-income countries,15 which have seen decreases in traffic-related TBI since the 1970s.16 The yearly incidence of TBI is estimated at 180–250 per 100,000 people in the US,17 281 per 100,000 in France, 361 per 100,000 in South Africa, 322 per 100,000 in Australia,18 and 430 per 100,000 in England.19 In the European Union the yearly aggregate incidence of TBI hospitalizations and fatalities is estimated at 235 per 100,000.20 The greatest number of TBIs occur in people aged 15–24.21 22 Because TBI is more common in young people23,and the highest rates of death and hospitalization due to TBI are in people over age 65.24 Regardless of age, TBI rates are higher in males.25 Men suffer twice as many TBIs as women do and have a fourfold risk of fatal head injury,26However, when matched for severity of injury, women appear to fare more poorly than men.27people with lower levels of education and employment and lower socioeconomic status are at greater risk.28
The main objective of this research is to assess TBI patients with Glasgow Coma Scale, to know about different causes of TBI whether it was due to a fall or a road traffic accident or any other trauma,mode of transportation to get patient to the hospital, time required to reach the hospital for his/her first treatment, consequences of TBI, different drugs used in hospital stay and to find out recovery or non recovery outcomes of TBI patients by distinguishing their GCS score before and after the treatment.
Endnotes
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2. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014 Sep;13(9):863.
3. Alves OL, Bullock R (2001). “Excitotoxic damage in traumatic brain injury”. In Clark RS, Kochanek P. Brain injury. Boston: Kluwer Academic Publishers. p. 1. ISBN 0-7923-7532-7.
4. Maas AI, Stocchetti N, Bullock R (August 2008). “Moderate and severe traumatic brain injury in adults”. Lancet Neurology. 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
5. “Coma” at Dorland’s Medical Dictionary
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8. Maas AI, Stocchetti N, Bullock R (August 2008). “Moderate and severe traumatic brain injury in adults”. Lancet Neurology. 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
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13. Maas AI, Stocchetti N, Bullock R (August 2008). “Moderate and severe traumatic brain injury in adults”. Lancet Neurology. 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
14. Park E, Bell JD, Baker AJ (April 2008). “Traumatic brain injury: Can the consequences be stopped?”. Canadian Medical Association Journal. 178 (9): 1163–70. doi:10.1503/cmaj.080282. PMC 2292762?. PMID 18427091.
15. Maas AI, Stocchetti N, Bullock R (August 2008). “Moderate and severe traumatic brain injury in adults”. Lancet Neurology. 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
16. Reilly P. (2007). “The impact of neurotrauma on society: An international perspective”. In Weber JT. Neurotrauma: New Insights Into Pathology and Treatment. Amsterdam: Academic Press. pp. 5–7. ISBN 0-444-53017-7.
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18. Hannay HJ, Howieson DB, Loring DW, Fischer JS, Lezak MD (2004). “Neuropathology for neuropsychologists”. In Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. Oxford Oxfordshire: Oxford University Press. pp. 158–62. ISBN 0-19-511121-4.
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20. Maas AI, Stocchetti N, Bullock R (August 2008). “Moderate and severe traumatic brain injury in adults”. Lancet Neurology. 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
21. Collins C, Dean J (2002). “Acquired brain injury”. In Turner A, Foster M, Johnson SE. Occupational Therapy and Physical Dysfunction: Principles, Skills and Practice. Edinburgh: Churchill Livingstone. pp. 395–96. ISBN 0-443-06224-2.
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28. Hannay HJ, Howieson DB, Loring DW, Fischer JS, Lezak MD (2004). “Neuropathology for neuropsychologists”. In Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. Oxford Oxfordshire: Oxford University Press. pp. 158–62. ISBN 0-19-511121-4.
