title: Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients.
abstract: OBJECTIVE
  To compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI) on predicting hospital discharge status of acute brain-injured 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma Research Center, Kashan University of Medical Sciences, Kashan, I.R. Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Mahdian
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Fazel
authors.forename: Esmaeil
authors.initials: E
authors.lastname: Fakharian
authors.forename: Hossein
authors.initials: H
authors.lastname: Akbari
authors.forename: Soroush
authors.initials: S
authors.lastname: Mahdian
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices