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At least 19 recordsLinked to original sources
PubMed1996

Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.

UNLABELLED: The Glasgow Coma Scale (GCS) has been shown to be a valuable tool in assessing the neurologic and physiologic status of critically ill patients. Unfortunately, the GCS requires assessment of the verbal response of the patient and this can be blocked by intubation. The purpose of this study was to assess the ability of a regression model based upon the eye and motor components of the GCS to accurately predict the verbal response of the GCS. The primary hypothesis was that the verbal response could be derived from the motor and eye responses of the GCS. METHODS: Data were collected prospectively in an intensive care unit computer data base. Patients were divided into training and test data sets. Linear regression was used to derive a model of verbal score from the motor and eye scores of the GCS in the training data set. Correlation between the actual and the predicted verbal scores was calculated. RESULTS: A total of 2,521 GCS assessments were available for analysis. The second order multiple regression model was an accurate predictor of the verbal score (Pearson's Correlation r = 0.9, R2 = 0.8, p = 0.0001) in 1,463 observations in the training data set. Second Order Multiple Regression Model: Estimated GCS Verbal = (2.3976) + [GCS Motor x (-0.9253)] + [GCS Eye x (-0.9214)] + [(GCS Motor)2 x (0.2208)] + [(GCS Eye)2 x (0.2318)] where r = 0.91, R2 = 0.83, and p = 0.0001. The accuracy of this model was confirmed by comparing the predicted verbal score to the actual verbal score in the test data set (n = 736, r = 0.92, R2 = 0.85, p = 0.0001) CONCLUSIONS: The GCS is a useful tool in the intensive care unit and a critical part of the APACHE II assessment of patient acuity. GCS has been shown to be a useful tool in its own right as a predictor of outcome in the critically ill. Its use is limited with intubation. (See Segatore M, Way C: Heart Lung 21:548, 1992; and Lieh-Lai MW, Theodorou AA, Sarnaik AP, et al: J Pediatr 120:195, 1992.) The present study demonstrates that a relatively simple regression model can use the eye and motor components of the GCS to predict the expected verbal component of the GCS, thus allowing the calculation of the GCS sum score in intubated patients.

Adult↗
PubMed1998

The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.

BACKGROUND: The Glasgow Coma Scale (GCS), which is the foundation of the Trauma Score, Trauma and Injury Severity Score, and the Acute Physiology and Chronic Health Evaluation scoring systems, requires a verbal response. In some series, up to 50% of injured patients must be excluded from analysis because of lack of a verbal component for the GCS. The present study extends previous work evaluating derivation of the verbal score from the eye and motor components of the GCS. METHODS: Data were obtained from a state trauma registry for 24,565 unintubated patients. The eye and motor scores were used in a previously published regression model to predict the verbal score: Derived Verbal Score = -0.3756 + Motor Score * (0.5713) + Eye Score * (0.4233). The correlation of the actual and derived verbal and GCS scales were assessed. In addition the ability of the actual and derived GCS to predict patient survival in a logistic regression model were analyzed using the PC SAS system for statistical analysis. The predictive power of the actual and the predicted GCS were compared using the area under the receiver operator characteristic curve and Hosmer-Lemeshow goodness-of-fit testing. RESULTS: A total of 24,085 patients were available for analysis. The mean actual verbal score was 4.4 +/- 1.3 versus a predicted verbal score of 4.3 +/- 1.2 (r = 0.90, p = 0.0001). The actual GCS was 13.6 + 3.5 versus a predicted GCS of 13.7 +/- 3.4 (r = 0.97, p = 0.0001). The results of the comparison of the prediction of survival in patients based on the actual GCS and the derived GCS show that the mean actual GCS was 13.5 + 3.5 versus 13.7 + 3.4 in the regression predicted model. The area under the receiver operator characteristic curve for predicting survival of the two values was similar at 0.868 for the actual GCS compared with 0.850 for the predicted GCS. CONCLUSIONS: The previously derived method of calculating the verbal score from the eye and motor scores is an excellent predictor of the actual verbal score. Furthermore, the derived GCS performed better than the actual GCS by several measures. The present study confirms previous work that a very accurate GCS can be derived in the absence of the verbal component.

Glasgow Coma Scale↗
PubMed2006

Intracranial pressure levels and single wave amplitudes, Glasgow Coma Score and Glasgow Outcome Score after subarachnoid haemorrhage.

OBJECT: To relate intracranial pressure (ICP) levels and single ICP wave amplitudes to the acute clinical state (Glasgow Coma Score, GCS) and final clinical outcome (Glasgow Outcome Score, GOS) in patients with subarachnoid haemorrhage (SAH). METHODS: Twenty-seven consecutive patients with severe SAH had their ICP and arterial blood pressure (ABP) continuously monitored during days 1-6 after SAH. The acute clinical state could be assessed in 11 non-sedated cases using the Glasgow Coma Scale, while outcome was assessed in all cases after 6 months using the Glasgow Outcome Scale. The ICP/ABP recordings were stored as raw data files and analyzed retrospectively. For every consecutive 6 seconds time window, mean ICP, mean cerebral perfusion pressure (CPP) and the mean ICP wave amplitude were computed. RESULTS: The GCS during days 1-6 after SAH was significantly related to the mean ICP wave amplitude, but not to the mean ICP or mean CPP. There was also a strong relationship between the mean ICP wave amplitude and GOS 6 months after SAH, with mean ICP wave amplitudes being significantly lower in those with moderate disability/good recovery, as compared with those with severe disability and death. Mean ICP was significantly higher in those who died than in the group with moderate disability/good recovery whereas mean CPP was not different between outcome groups. CONCLUSIONS: In this small patient group the mean ICP wave amplitude during days 1-6 after SAH was related to the acute clinical state (GCS) as well as to the clinical outcome (GOS) 6 months after SAH. Similar relationships were not found for mean ICP or the mean CPP, except for a higher mean ICP in those who died than in those with moderate disability/good recovery.

Aged↗
PubMed2001

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury.

OBJECTIVE: To study the effect of hyperbaric oxy gen (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 a nd 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.

Adult↗
PubMed1998

Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable.

Adolescent↗
PubMed1997

The sexual behaviour of international travellers at two Glasgow GUM clinics. Glasgow genitourinary medicine.

A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 3-month periods in 1993 and 1994. Three hundred and twenty-five attendees who had travelled abroad in the preceding 3 months completed anonymous self-administered questionnaires about their sexual behaviour during these recent journeys abroad. There were 112 women and 213 men (185 heterosexuals and 28 homosexuals). Twenty-two (19.6%) women, 56 (31%) heterosexual men and 13 (42%) homosexual men had a sexual contact with a new partner while abroad. Of those who had had a new sexual contact abroad, 11 women (50% of those who had sex with a new partner) and 33 heterosexual men (59% of those who had sex with a new partner) were inconsistent users of condoms. Analysis of data found that homosexual and heterosexual men, and business travellers, are at increased risk of exposure to sexually transmitted diseases, including HIV infection, and should be targeted with safer sex health promotion prior to travel.

Adolescent↗
PubMedDate not supplied

[Correlation of brain stem evoked response audiometry (BERA) with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS)].

The diagnostic value of electric responses from the brain stem (BERA) in neurosurgical patients is still a matter for debate in the literature. Therefore in the study an attempt was made to determine the relationship between GCS scores and BERA recordings. Participants in the study were 64 patients with various types of brain damage. Evoked potentials from the brain stem were registered using the Hortmann BERAmodul apparatus. To facilitate the interpretation of results a special scale was developed for quantitative measurement of changes in BERA recordings. Abnormalities in BERA recordings were reflected in changes in GCS scores, and correlation between the two dimensions was found to be statistically significant. The relationship between BERA recordings and GOS scores was also significant: pathological changes in BERA recordings assessed as severe were associated with an unfavorable therapeutic outcome in the GOS. The presented findings indicate auditory evoked brain stem response (BERA) usefulness for objective evaluation of brain-damaged patients' clinical state.

Adolescent↗
PubMed1982

Duncan Guthrie Institute of Medical Genetics, Glasgow, University of Glasgow, Scotland.

Unbalanced chromosome aberrations detected by routine chromosome diagnostic services can be used for gene mapping by gene dosage. This procedure, once discredited by early observations in Down's syndrome, has now provided some of the most precise intrachromosomal gene localizations known and these are reviewed. Cytogeneticists have an obligation to see that every opportunity is taken to obtain mapping information from suitable cases. Interpretation of cytogenetic findings may be improved by application of appropriate gene dosage studies, and examples are described in which a diagnosis was made possible by such studies. Cytogeneticists may also contribute to human gene mapping by application of the technique of in situ molecular hybridization. The localization of the immunoglobulin kappa light chain genes (IGKV) to the short arm of chromosome 2 reported at this workshop provides the first example of the localization of an unassigned, unique DNA gene sequence by this method. Combined with the use of chromosomal translocations, resolution of assignments to chromosomal sub-bands is possible, and, as suitable DNA clones become available, the technique should have wide applicability in human gene mapping.

Chromosome Aberrations↗
PubMed1993

Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study.

OBJECTIVE: To investigate the ability of the Glasgow Coma Scale score to predict hospital mortality rate for adult medical-surgical intensive care unit (ICU) patients without trauma. DESIGN: A prospective cohort analysis of adult medical-surgical patients from a nationally representative sample of 40 U.S. hospitals. PATIENTS: 15,973 consecutive, nontraumatic ICU admissions and a comparison group of 687 head trauma admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients' gender, age, treatment location before ICU admission, comorbidities, admission diagnosis, daily physiologic measurements, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation (APACHE III) score, subsequent hospital mortality rate, and unit-specific sedation practices were noted. Hospital mortality rates were stratified by the first ICU day Glasgow Coma Scale score for all admissions. The relationship between the Glasgow Coma Scale score and outcome for two high mortality medical diagnoses (post-cardiac arrest and sepsis) were also examined and compared to the relationship found in patients with head trauma. The Glasgow Coma Scale score on ICU admission had a highly significant (r2 = .922, p < .0001) but nonlinear relationship with subsequent outcome in ICU patients without trauma. Discrimination of patients into high- or low-risk prognostic groups was good, but discrimination in the intermediate levels (Glasgow Coma Scale score of 7 to 11) was reduced. This relationship varied within the operative and nonoperative groups, and also within different disease categories, various age groups, and certain ranges of the Glasgow Coma Scale score. A reduced initial Glasgow Coma Scale score associated with sepsis was a combination of factors associated with a higher mortality rate than that found in patients with head trauma. The proportion of patients who could not be assigned a Glasgow Coma Scale score because of sedation/paralysis varied widely across ICUs. The overall predictive capability of the APACHE III Prognostic Scoring System was improved by incorporating the Glasgow Coma Scale score. CONCLUSIONS: We demonstrated the prognostic importance of admission levels of consciousness as measured by the Glasgow Coma Scale score on ICU and hospital mortality rates. We concluded that the Glasgow Coma Scale score may be used to stratify and predict mortality risk in general intensive care patients, but lack of sensitivity in the intermediate range of Glasgow Coma Scale Score should be noted. Ideally, the Glasgow Coma Scale score should also be applied in the context of other physiologic information and the patient's specific diagnosis. Variation in the use of sedatives in different ICUs means that imputing or substituting a value other than normal for an unobtainable Glasgow Coma Scale score may introduce a substantial treatment bias into subsequent outcome predictions.

Coma↗
PubMed1992

Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury.

OBJECTIVE: To study the hypothesis that, in the absence of an ischemic-hypoxic state, children with severe traumatic brain injury and with unfavorable Glasgow Coma Scale scores may have good recovery. DESIGN: Retrospective, observational, cross-sectional study with factorial design. SETTING: Inpatient population in a university hospital. PATIENTS: Seventy-nine children with traumatic brain injury admitted to the intensive care unit. INTERVENTIONS: All patients received close monitoring and strict control of intracranial pressure (less than 20 mm Hg) and cerebral perfusion pressure (greater than 60 mm Hg). MEASUREMENTS AND RESULTS: Admission Glasgow Coma Scale score, survival, need for cardiopulmonary resuscitation, presence of shock, peak intracranial pressure, duration of coma, Glasgow Outcome Scale score, and the results of neuropsychologic tests were analyzed. Of 79 children, 70 (89%) survived. Although the mortality rate was higher among patients with Glasgow Coma Scale scores of 3 to 5, 14 (64%) of 22 of these children survived. Nonsurvivors had a significantly higher incidence of shock and need for cardiopulmonary resuscitation. Except for two patients who had prolonged hypoxemia, all children, including those with Glasgow Coma Scale scores of 3 to 5, had a satisfactory outcome (Glasgow Outcome Scale scores of 4 or 5). Neuropsychologic outcome was not significantly different in the survivors with Glasgow Coma Scale scores of 3 to 5 and those with Glasgow Coma Scale scores of 6 or more. CONCLUSIONS: A low Glasgow Coma Scale score does not always accurately predict the outcome of severe traumatic brain injury; in the absence of hypoxic-ischemic injury, children with traumatic brain injury and Glasgow Coma Scale scores of 3 to 5 can recover independent function.

Adolescent↗
PubMed2000

[NEC--neonatal necrotising enterocolitis--methods of treatment and outcome: a comparative analysis of Scottish (Glasgow) and Polish (Western Pomerania) cases].

The aim of the work was to perform a comparative analysis of medical files of 125 neonates with necrotising enterocolitis treated between 1990 and 1995 in two regional centres: Glasgow (Scotland) and Western Pomerania (Poland), and to search for factors constituting an indication for surgery in NEC. The following data contained in the medical documentation of NEC cases have been analyzed: maternal risk factors, perinatal abnormalities, neonatal risk factors, procedures performed in the neonate, feeding practices, clinical and radiological signs, time of onset of the disease, clinical staging of NEC according to Bell (modified by Walsh and Kliegman), methods of treatment, postoperative course and outcome. The analysis was performed in the whole material and in the subgroup of newborns weighing < 1500 g (low/extremely low birth weight babies). Glasgow neonates with NEC had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower leukocyte count and shorter time of onset of the disease. In the subgroup of newborns weighing less than 1500 g, Glasgow neonates had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower 1 minute Apgar score, pH and base excess (BE) values. Glasgow clinical NEC stage was significantly more severe (IIB-IIIB) when compared to Pomeranian neonates. A higher proportion of full-term neonates in the present study--31.2%--was diagnosed with NEC than in the literature. Hyponatremia with severe acidosis and low platelet count (especially below 100 x 10(9)/L) may constitute an easily available laboratory finding serving as an indicator for surgical intervention in NEC. Statistical analysis revealed that the selection of treatment was influenced in the Glasgow group by birth weight and in the Pomeranian group by the clinical stage of NEC. Overall mortality was 32.8% in the whole group of 125 neonates, 34.4% in the Glasgow and 31.2% in the Pomeranian group. However, Glasgow neonates had significantly lower birth weight and gestational age and were more severely ill. The mortality in the subgroup of Scottish neonates with primary peritoneal drainage was 55.5%, the majority presenting with significantly lower birth weight and stage IIIB of necrotising enterocolitis. In conservatively treated neonates, mortality was 13% in the whole group, 9% in the Glasgow group and 15% in the Pomeranian group. Overall mortality in neonates treated surgically was 46.6%. In the Glasgow group it was 23% without and 42% with primary peritoneal drainage, respectively. Surgical mortality in the Pomeranian group was 42%. Overall mortality was 5.6% in full-term newborns, 3.2% in the Glasgow group and 7.8% in the Pomeranian group. Primary peritoneal drainage is a valuable, mildly invasive method of initial, and in some cases final, treatment in severely ill NEC babies, especially with low birth weight. This method was not used in the Pomeranian group.

Anastomosis, Surgical↗
PubMed1993

HIV prevalence and HIV risk behaviour among injecting drug users in London and Glasgow.

This paper reports on the British findings from a cross-national study of HIV prevalence and HIV risk behaviour among 1,037 injecting drug users (IDUs) recruited from a variety of treatment- and community-based settings during 1990. Confirmed HIV saliva test results show 12.8% (63) of London respondents and 1.8% (8) of Glasgow respondents to be HIV antibody positive. Among London respondents, a higher rate of prevalence was found in those with no experience of drug treatment. A greater proportion of Glasgow respondents (68%) than London respondents (47%) reported sharing used injecting equipment in the 6 months prior to interview. The majority (88% in both cities) attempted cleaning borrowed equipment, although less than a third (31% in London and 30% in Glasgow) usually used bleach. The majority of respondents (71% in London and 82% in Glasgow) were sexually active with partners of the opposite sex in the last 6 months, and respondents had a mean number of 2.4 non-commercial sexual partners in London and 2.1 in Glasgow. Levels of reported condom use were comparable with reports in the heterosexual population as a whole, with 70% of London respondents and 75% of Glasgow respondents never using condoms with primary partners, and 34% of London and 52% of Glasgow respondents never using condoms with casual partners. Half (48%) of London respondents and 42% of Glasgow respondents reported sexual intercourse with non-injecting private sexual partners, while 14% of female respondents in London and 22% in Glasgow had engaged in prostitution. Levels of risk-taking in each of the two cities indicate the potential for further transmission of HIV among drug injectors, and their sexual and sharing partners.

Adult↗