Evidence map›Paper›PMID 31236497›Full record

ArticleNeurobiology of sleep and circadian rhythms2017

Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients.

John K Yue, Caitlin K Robinson, Ethan A Winkler, Pavan S Upadhyayula, John F Burke, Romain Pirracchio, Catherine G Suen, Hansen Deng, Laura B Ngwenya, Sanjay S Dhall and 2 more

Abstract read
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In one paragraph

Article in Neurobiology of sleep and circadian rhythms, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Current Trends in Biomarkers for Traumatic Brain Injury.Open access journal of neurology & neurosurgery · 2020
    Article
  4. Article
4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

John K YueDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Caitlin K RobinsonDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Ethan A WinklerDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Pavan S UpadhyayulaDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
John F BurkeDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Romain PirracchioDepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, United States.
Catherine G SuenDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Hansen DengDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Laura B NgwenyaDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Sanjay S DhallDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Geoffrey T ManleyDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.
Phiroz E TaraporeDepartment of Neurological Surgery, University of California, San Francisco, CA, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe Glasgow Coma Scale (GCS) score is the primary method of assessing consciousness after traumatic brain injury (TBI), and the clinical standard for classifying TBI severity. There is scant literature discerning the influence of circadian rhythms or emergency department (ED) arrival hour on this important clinical tool.

methodsRetrospective cohort analysis of adult patients suffering blunt TBI using the National Sample Program of the National Trauma Data Bank, years 2003-2006. ED arrival GCS score was characterized by midday (10 a.m.-4 p.m.) and midnight (12 a.m.-6 a.m.) cohorts (N=24548). Proportions and standard errors are reported for descriptive data. Multivariable regressions using odds ratios (OR), mean differences (

resultsPatients were 42.48±0.13-years-old and 69.5% male. GCS score was 12.68±0.13 (77.2% mild, 5.2% moderate, 17.6% severe-TBI). Overall, patients were injured primarily via motor vehicle accidents (52.2%) and falls (24.2%), and 85.7% were admitted to hospital (33.5% ICU). Injury severity score did not differ between day and nighttime admissions.Nighttime admissions associated with decreased systemic comorbidities (p<0.001) and increased likelihood of alcohol abuse and drug intoxication (p<0.001). GCS score demonstrated circadian rhythmicity with peak at 12 p.m. (13.03±0.08) and nadir at 4am (12.12±0.12). Midnight patients demonstrated lower GCS (12 a.m.-6 a.m.: 12.23±0.04; 10 a.m.-4 p.m.: 12.95±0.03, p<0.001). Multivariable regression adjusted for demographic and injury factors confirmed that midnight-hours independently associated with decreased GCS (

conclusionsNighttime TBI patients present with decreased GCS scores and are admitted to ICU at higher rates, yet have fewer prior comorbidities and similar systemic injuries. The interaction between nighttime hours and decreased GCS score on ICU admissions has important implications for clinical assessment/triage.

Indexed as

CAD, coronary artery diseaseCCI, Charlson Comorbidity IndexCI, confidence intervalCircadianCOPD, chronic obstructive pulmonary diseaseCRSD, circadian rhythm sleep disorderED, emergency departmentEmergency departmentGABA, gamma-aminobutyric acidGCS, Glasgow Coma ScaleGlasgow Coma ScaleHospital admissionICD-9, International Classification of Diseases, 9th RevisionICU, intensive care unitIQR, interquartile rangeISS, injury severity scoreMVA, motor vehicle accidentNeurologic deficitNSP, National Sample ProgramNTDB, National Trauma Data BankOR, odds ratioREM, rapid eye movementRHT, reticulohypothalamic tractSCN, suprachiasmatic nucleusSD, standard deviationSE, standard errorTBI, traumatic brain injuryTraumatic brain injury

Identifiers

PMID31236497
PMCPMC6575566

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.