title: Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?
abstract: OBJECTIVE
  The Glasgow Coma Scale (GCS) is used commonly for assessing patients' neurologic condition and outcome in intensive care units (ICUs); however, its reliability in cardiac surgical patients has been questioned. It has been claimed that active sedation is the cause of its unsuitability for these patients. This study aimed to compare the accuracy of GCS in cardiac surgical patients with and without active sedation to find out if the inapplicability of GCS in surgical patients is related to active sedation.
  
  
  METHODS
  This was an observational cohort study.
  
  
  METHODS
  The study was conducted in a cardiac surgical intensive care unit between January 1, 2007 and December 31, 2009.
  
  
  METHODS
  All consecutive adult cardiac surgical patients were included in this study.
  
  
  METHODS
  All types of cardiac surgical procedures performed during the study period were included without any exceptions. The study population was divided into 2 groups: sedated and non-sedated.
  
  
  RESULTS
  GCS was calculated daily for the first 7 postoperative days. The authors developed a new 4-point neurologic descriptor (ND): (1) neurologically free, (2) ICU psychosis, (3) actively sedated, and (4) documented focal neurologic deficits. The accuracy of both scales (GCS and ND) at predicting ICU mortality was compared by replacing the GCS in the Sequential Organ Failure Assessment (SOFA) score with the new ND, producing a modified SOFA. GCS was not an accurate outcome predictor in non-sedated or sedated patients. The ND was superior to GCS. Correspondingly, the modified SOFA showed a significantly higher accuracy of ICU-mortality prediction than the original SOFA.
  
  
  CONCLUSIONS
  Regardless of active sedation, GCS is not accurate at outcome prediction for cardiac surgical patients. The suggested ND is a simple and more accurate risk stratification variable in cardiac surgical ICUs.
authors.affiliation: Department of Anesthesia and Operative Intensive Care Medicine, Friedrich-Wilhelms-University of Bonn, Bonn, Germany. Electronic address: akmalbadreldin@yahoo.com.
authors.forename: Akmal M A
authors.initials: AM
authors.lastname: Badreldin
authors.affiliation: School of Medicine, University of Cologne, Cologne, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Doerr
authors.affiliation: Department of Anesthesia and Operative Intensive Care Medicine, Friedrich-Wilhelms-University of Bonn, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Putensen
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Bayer
authors.affiliation: Department of Cardiology, Friedrich-Schiller-University of Jena, Jena, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Noutsias
authors.affiliation: Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Khosro
authors.initials: K
authors.lastname: Hekmat
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards* / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: Glasgow Coma Scale; cardiac surgery; neurologic status; outcome prediction