title: Prehospital heart rate and blood pressure increase the positive predictive value of the Glasgow Coma Scale for high-mortality traumatic brain injury.
abstract: We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. Vital-sign data were electronically archived and analyzed. We examined the relative risk of severe head Abbreviated Injury Scale (AIS) 5-6 as a function of the GCS, systolic blood pressure (SBP), heart rate (HR), and respiratory rate (RR). We created multi-variate logistic regression models and, using DeLong's test, compared their area under receiver operating characteristic curves (ROC AUCs) for three outcomes: head AIS 5-6, all-cause mortality, and either head AIS 5-6 or neurosurgical procedure. We found significant bimodal relationships between head AIS 5-6 versus SBP and HR, but not RR. When the GCS was <15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk.
authors.affiliation: 1 Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center , U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Reisner
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Chen
authors.forename: Kamal
authors.initials: K
authors.lastname: Kumar
authors.forename: Jaques
authors.initials: J
authors.lastname: Reifman
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001794:Blood Pressure; D001930:Brain Injuries / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies