西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow co...西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的"Glasgow coma scale"多种多样,容易造成初学者和使用者的迷惑。本文复习有关"Glasgow coma scale"的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版。结合英式英语、美式英语和汉语的语言文化特点,新译了"Glasgow coma scale",以方便医护人员使用。展开更多
BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver ...BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P【0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.展开更多
This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural ...This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).展开更多
Glasgow coma scale is the most cited paper in neurosurgery. It has vast implications in the fields of neurology and neurosurgery. But lack of proper understanding in the neuro-anatomical basis of the score is the Achi...Glasgow coma scale is the most cited paper in neurosurgery. It has vast implications in the fields of neurology and neurosurgery. But lack of proper understanding in the neuro-anatomical basis of the score is the Achilles heel in proper utilization of the same. Herein we review the anatomical aspects behind each variable in the score. We also discuss common limitations of the score and highlight future directives to limit the same.展开更多
Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 recei...Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.展开更多
Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology ...Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.展开更多
Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 1...Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel＇s National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.展开更多
Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive stud...Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.展开更多
Background： Whether the Glasgow Coma Scale （GCS） can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component （GCS-M）/Simplified Motor Score （SMS） t...Background： Whether the Glasgow Coma Scale （GCS） can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component （GCS-M）/Simplified Motor Score （SMS） to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients. Methods： A retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit （NCU）. Outcomes were death and unfavorable prognosis （modified Rankin Scale： 5-6） at NCU discharge. The receiver operating characteristic （ROC） curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves （AUCs） was performed using the Z-test.Results： Of 106 patients included in the study, 41 （38.7%） patients died, and 69 （65.1%） patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale＇s predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h （0.721 vs. 0.717, Z = 0.135, P = 0.893） and 72 h （0.730 vs. 0.765, Z = 1.887, P = 0.060）, in predicting poor prognosis at 0 h （0.827 vs. 0.819, Z = 0.395, P = 0.693）, 24 h （0.771 vs. 0.760, Z = 0.944, P = 0.345）, 48 h （0.732 vs. 0.741, Z= 0.593, P= 0.590）, and 72 h （0.775 vs. 0.780, Z= 0.302, P= 0.763）. AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death （0.964 vs. 0.964, P = 1.000） and poor prognosis （ 1.000 vs. 1.000, P = 1.000） for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M （〈0.700）, in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. The SMS AUCs （〈0.700） in predicting outcomes were poor. Conclusions： The GCS-M approaches the same test performance as the GCS in assessing the prognosis ofintubatcd acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.展开更多
Objective：To compare the value of Glasgow coma scale （GCS） and cerebral state index （CSI）on predicting hospital discharge status of acute braininjured patients.Methods：In 60 brain-injured patients who did not re...Objective：To compare the value of Glasgow coma scale （GCS） and cerebral state index （CSI）on predicting hospital discharge status of acute braininjured patients.Methods：In 60 brain-injured patients who did not receive sedatives,GCS and CSI were measured daily during the first 10 days of hospitalization.The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic （ROC） curve regarding the time of admission and third day of hospitalization.Sensitivity,specificity and other predictive values for both indices were calculated.Results：Of the 60 assessed patients,14 patients had mild,13 patients had moderate and 33 patients had severe injuries.During the course of the study,17 patients （28.3％） deteriorated in their situation and died.The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital.GCS＜4.5 and CSI＜64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients.For the first day of hospitalization,the area under ROC curve was 0.947 for GCS and 0.732 for CSI.Conclusion：GCS score at ICU admission is a good predictor of in-hospital mortality.GCS＜4.5 and CSI＜64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.展开更多
Background:Acquired brain injury(ABI)is caused by trauma or nontrauma to the brain after birth.Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pre...Background:Acquired brain injury(ABI)is caused by trauma or nontrauma to the brain after birth.Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure.After traumatic brain injury,there is an increase in air content in the brain and an increase in volume of blood flow to the brain,which can cause increased intracranial pressure,herniation of brain tissue,impaired cerebral perfusion,and brain damage.Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure.Near-infrared spectroscopy(NIRS)and central venous pressure(CVP)monitoring are also associated with cerebral perfusion.This study aimed to determine the relationship between the Glasgow Coma Scale(GCS)scores and CVP and NIRS values in patients with ABI.Methods:This prospective analytical study used a cross-sectional design to compareGCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit(ICU)of Haji Adam Malik Hospital Medan.GCS,CVP,and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed,or median(interquartile range)values if the data were not normally distributed.The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed,or the Spearman test if the data were not normally distributed.Results:In this study,the mean GCS score and CVP values were 7.04±2.69 and 5.63±25.82 mmHg,respectively.The right tissue oxygen saturation(StO2)was 55.61%±18.72%,and the left StO2 was 57.57%±17.48%with normally distributed data.There was no correlation between GCS scores and CVP values(P=0.829),and no correlation between moderate GCS scores and right and left StO2(P=0.343;P=0.121);however,there was a significantly strong positive correlation between severe GCS scores and right and left StO2(P=0.028,r=0.656;P=0.005,r=0.777).Conclusion:There was no significant correlation between GCS scores and CVP values,and no correlation between moderate GCS scores and NIRS values;however,there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.展开更多
目的:探讨回阳醒神针法对卒中后浅昏迷患者脑电频带能量及促醒效果的影响。方法:将40例卒中后浅昏迷患者随机分为观察组(西医治疗+回阳醒神针法)和对照组(西医治疗+常规针刺治疗),疗程4周。采用脑电频带能量分析技术检测δ、α、β频段...目的:探讨回阳醒神针法对卒中后浅昏迷患者脑电频带能量及促醒效果的影响。方法:将40例卒中后浅昏迷患者随机分为观察组(西医治疗+回阳醒神针法)和对照组(西医治疗+常规针刺治疗),疗程4周。采用脑电频带能量分析技术检测δ、α、β频段能量变化,结合改良的昏迷恢复量表(The Coma Recovery Scale-Revised,CRS-R)、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、全面无反应性量表(Full Outline of Unresponsiveness Scale,FOUR)评估促醒效果。结果:治疗后,与对照组相比,试验组CRS-R量表、GCS量表及FOUR量表评分均明显升高,差异均具有统计学意义(P<0.01);试验组脑电频带能量δ波显著降低,α波、β波显著上升,差异具有统计学意义(P<0.01)。结论:回阳醒神针法通过调节脑电节律,增强高频能量活动,促进卒中后浅昏迷患者意识恢复,“回阳醒神”针法可促使浅昏迷患者大脑电生理活动从抑制状态向活跃状态转变,且效果优于常规针刺疗法,与CRS-R量表、GCS量表以及FOUR量表评估的意识水平临床改善程度相符合。展开更多
文摘西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的"Glasgow coma scale"多种多样,容易造成初学者和使用者的迷惑。本文复习有关"Glasgow coma scale"的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版。结合英式英语、美式英语和汉语的语言文化特点,新译了"Glasgow coma scale",以方便医护人员使用。
文摘BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P【0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.
文摘This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).
文摘Glasgow coma scale is the most cited paper in neurosurgery. It has vast implications in the fields of neurology and neurosurgery. But lack of proper understanding in the neuro-anatomical basis of the score is the Achilles heel in proper utilization of the same. Herein we review the anatomical aspects behind each variable in the score. We also discuss common limitations of the score and highlight future directives to limit the same.
文摘Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.
文摘Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.
文摘Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel＇s National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.
文摘Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.
基金The study was supported by grants from the National High Technology Research and Development Program of China （863 Program, No. 2015AA020514） and the National Natural Science Foundation of China （No. 81671037）.
文摘Background： Whether the Glasgow Coma Scale （GCS） can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component （GCS-M）/Simplified Motor Score （SMS） to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients. Methods： A retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit （NCU）. Outcomes were death and unfavorable prognosis （modified Rankin Scale： 5-6） at NCU discharge. The receiver operating characteristic （ROC） curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves （AUCs） was performed using the Z-test.Results： Of 106 patients included in the study, 41 （38.7%） patients died, and 69 （65.1%） patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale＇s predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h （0.721 vs. 0.717, Z = 0.135, P = 0.893） and 72 h （0.730 vs. 0.765, Z = 1.887, P = 0.060）, in predicting poor prognosis at 0 h （0.827 vs. 0.819, Z = 0.395, P = 0.693）, 24 h （0.771 vs. 0.760, Z = 0.944, P = 0.345）, 48 h （0.732 vs. 0.741, Z= 0.593, P= 0.590）, and 72 h （0.775 vs. 0.780, Z= 0.302, P= 0.763）. AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death （0.964 vs. 0.964, P = 1.000） and poor prognosis （ 1.000 vs. 1.000, P = 1.000） for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M （〈0.700）, in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. The SMS AUCs （〈0.700） in predicting outcomes were poor. Conclusions： The GCS-M approaches the same test performance as the GCS in assessing the prognosis ofintubatcd acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.
文摘Objective：To compare the value of Glasgow coma scale （GCS） and cerebral state index （CSI）on predicting hospital discharge status of acute braininjured patients.Methods：In 60 brain-injured patients who did not receive sedatives,GCS and CSI were measured daily during the first 10 days of hospitalization.The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic （ROC） curve regarding the time of admission and third day of hospitalization.Sensitivity,specificity and other predictive values for both indices were calculated.Results：Of the 60 assessed patients,14 patients had mild,13 patients had moderate and 33 patients had severe injuries.During the course of the study,17 patients （28.3％） deteriorated in their situation and died.The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital.GCS＜4.5 and CSI＜64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients.For the first day of hospitalization,the area under ROC curve was 0.947 for GCS and 0.732 for CSI.Conclusion：GCS score at ICU admission is a good predictor of in-hospital mortality.GCS＜4.5 and CSI＜64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.
文摘Background:Acquired brain injury(ABI)is caused by trauma or nontrauma to the brain after birth.Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure.After traumatic brain injury,there is an increase in air content in the brain and an increase in volume of blood flow to the brain,which can cause increased intracranial pressure,herniation of brain tissue,impaired cerebral perfusion,and brain damage.Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure.Near-infrared spectroscopy(NIRS)and central venous pressure(CVP)monitoring are also associated with cerebral perfusion.This study aimed to determine the relationship between the Glasgow Coma Scale(GCS)scores and CVP and NIRS values in patients with ABI.Methods:This prospective analytical study used a cross-sectional design to compareGCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit(ICU)of Haji Adam Malik Hospital Medan.GCS,CVP,and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed,or median(interquartile range)values if the data were not normally distributed.The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed,or the Spearman test if the data were not normally distributed.Results:In this study,the mean GCS score and CVP values were 7.04±2.69 and 5.63±25.82 mmHg,respectively.The right tissue oxygen saturation(StO2)was 55.61%±18.72%,and the left StO2 was 57.57%±17.48%with normally distributed data.There was no correlation between GCS scores and CVP values(P=0.829),and no correlation between moderate GCS scores and right and left StO2(P=0.343;P=0.121);however,there was a significantly strong positive correlation between severe GCS scores and right and left StO2(P=0.028,r=0.656;P=0.005,r=0.777).Conclusion:There was no significant correlation between GCS scores and CVP values,and no correlation between moderate GCS scores and NIRS values;however,there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.
文摘目的:探讨回阳醒神针法对卒中后浅昏迷患者脑电频带能量及促醒效果的影响。方法:将40例卒中后浅昏迷患者随机分为观察组(西医治疗+回阳醒神针法)和对照组(西医治疗+常规针刺治疗),疗程4周。采用脑电频带能量分析技术检测δ、α、β频段能量变化,结合改良的昏迷恢复量表(The Coma Recovery Scale-Revised,CRS-R)、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、全面无反应性量表(Full Outline of Unresponsiveness Scale,FOUR)评估促醒效果。结果:治疗后,与对照组相比,试验组CRS-R量表、GCS量表及FOUR量表评分均明显升高,差异均具有统计学意义(P<0.01);试验组脑电频带能量δ波显著降低,α波、β波显著上升,差异具有统计学意义(P<0.01)。结论:回阳醒神针法通过调节脑电节律,增强高频能量活动,促进卒中后浅昏迷患者意识恢复,“回阳醒神”针法可促使浅昏迷患者大脑电生理活动从抑制状态向活跃状态转变,且效果优于常规针刺疗法,与CRS-R量表、GCS量表以及FOUR量表评估的意识水平临床改善程度相符合。
