The impact of Glasgow Coma Scale–age prognosis score on geriatric traumatic brain injury outcomes

Muhammad Khan, Terence OKeeffe, Faisal Jehan, Narong Kulvatunyou, Abdullah Kattaa, Lynn Gries, Andrew Tang, Bellal Joseph

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients. Methods We performed a 1-y (2011) retrospective analysis of isolated geriatric TBI patients (age ≥65 y, head abbreviated injury score [AIS] ≥ 3, and other body AIS < 3) in the National Trauma Data Bank. We calculated a Glasgow Coma Scale (GCS)–age prognosis (GAP) score (age/GCS score) for all patients. Outcome measures were in-hospital adverse outcomes (mortality and Rehab/skilled nursing facility discharge disposition). Regression analysis and receiver operator characteristic curve analysis were performed to determine the discriminatory power of GAP score. Results A total of 8750 geriatric patients with TBI were included. Mean age was 77.8 ± 7.1 y, the median (interquartile range) GCS was 15 (13-15), and the median (interquartile range) head AIS was 4 (3-4). The overall in-hospital mortality rate was 12.7%, and 34.2% of the patients were discharged home. As the GAP score increased, the mortality rate increased and discharge to-home decreased. Receiver operator characteristic curve analysis revealed excellent discriminatory power for mortality (area under the curve: 0.826). Above a GAP score of 12, the mortality rate was >50% and more than 45% of the patients were discharged to Rehab/skilled nursing facility. Conclusions For geriatric patients with TBI, a simple GAP score reliably predicts outcomes. A score above 12 results in a drastic increase in mortality and an adverse discharge disposition. This simple tool may help clinicians provide accurate prognostic information to patients' families.

Original languageEnglish (US)
Pages (from-to)109-114
Number of pages6
JournalJournal of Surgical Research
Volume216
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Coma
Geriatrics
Skilled Nursing Facilities
Traumatic Brain Injury
Craniocerebral Trauma
Decision Making
Communication
Mortality
Wounds and Injuries
Population

Keywords

  • Geriatric population
  • Outcomes
  • Prognostic model
  • TBI

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of Glasgow Coma Scale–age prognosis score on geriatric traumatic brain injury outcomes. / Khan, Muhammad; OKeeffe, Terence; Jehan, Faisal; Kulvatunyou, Narong; Kattaa, Abdullah; Gries, Lynn; Tang, Andrew; Joseph, Bellal.

In: Journal of Surgical Research, Vol. 216, 01.08.2017, p. 109-114.

Research output: Contribution to journalArticle

Khan, Muhammad ; OKeeffe, Terence ; Jehan, Faisal ; Kulvatunyou, Narong ; Kattaa, Abdullah ; Gries, Lynn ; Tang, Andrew ; Joseph, Bellal. / The impact of Glasgow Coma Scale–age prognosis score on geriatric traumatic brain injury outcomes. In: Journal of Surgical Research. 2017 ; Vol. 216. pp. 109-114.
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AU - OKeeffe, Terence

AU - Jehan, Faisal

AU - Kulvatunyou, Narong

AU - Kattaa, Abdullah

AU - Gries, Lynn

AU - Tang, Andrew

AU - Joseph, Bellal

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N2 - Background As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients. Methods We performed a 1-y (2011) retrospective analysis of isolated geriatric TBI patients (age ≥65 y, head abbreviated injury score [AIS] ≥ 3, and other body AIS < 3) in the National Trauma Data Bank. We calculated a Glasgow Coma Scale (GCS)–age prognosis (GAP) score (age/GCS score) for all patients. Outcome measures were in-hospital adverse outcomes (mortality and Rehab/skilled nursing facility discharge disposition). Regression analysis and receiver operator characteristic curve analysis were performed to determine the discriminatory power of GAP score. Results A total of 8750 geriatric patients with TBI were included. Mean age was 77.8 ± 7.1 y, the median (interquartile range) GCS was 15 (13-15), and the median (interquartile range) head AIS was 4 (3-4). The overall in-hospital mortality rate was 12.7%, and 34.2% of the patients were discharged home. As the GAP score increased, the mortality rate increased and discharge to-home decreased. Receiver operator characteristic curve analysis revealed excellent discriminatory power for mortality (area under the curve: 0.826). Above a GAP score of 12, the mortality rate was >50% and more than 45% of the patients were discharged to Rehab/skilled nursing facility. Conclusions For geriatric patients with TBI, a simple GAP score reliably predicts outcomes. A score above 12 results in a drastic increase in mortality and an adverse discharge disposition. This simple tool may help clinicians provide accurate prognostic information to patients' families.

AB - Background As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients. Methods We performed a 1-y (2011) retrospective analysis of isolated geriatric TBI patients (age ≥65 y, head abbreviated injury score [AIS] ≥ 3, and other body AIS < 3) in the National Trauma Data Bank. We calculated a Glasgow Coma Scale (GCS)–age prognosis (GAP) score (age/GCS score) for all patients. Outcome measures were in-hospital adverse outcomes (mortality and Rehab/skilled nursing facility discharge disposition). Regression analysis and receiver operator characteristic curve analysis were performed to determine the discriminatory power of GAP score. Results A total of 8750 geriatric patients with TBI were included. Mean age was 77.8 ± 7.1 y, the median (interquartile range) GCS was 15 (13-15), and the median (interquartile range) head AIS was 4 (3-4). The overall in-hospital mortality rate was 12.7%, and 34.2% of the patients were discharged home. As the GAP score increased, the mortality rate increased and discharge to-home decreased. Receiver operator characteristic curve analysis revealed excellent discriminatory power for mortality (area under the curve: 0.826). Above a GAP score of 12, the mortality rate was >50% and more than 45% of the patients were discharged to Rehab/skilled nursing facility. Conclusions For geriatric patients with TBI, a simple GAP score reliably predicts outcomes. A score above 12 results in a drastic increase in mortality and an adverse discharge disposition. This simple tool may help clinicians provide accurate prognostic information to patients' families.

KW - Geriatric population

KW - Outcomes

KW - Prognostic model

KW - TBI

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