ArticleSurgery2025
Beyond Glasgow Coma Scale: Prehospital prediction of traumatic brain injury.
Article in Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Graded traumatic brain injury severity differentially modulates microglial and astrocytic polarization states and response to minocycline.Neuroprotection (Chichester, England) · 2026Article
- Improving mortality prediction in older adults with traumatic brain injury: incorporating neurological and imaging scores into Geriatric Trauma Outcome Score.World journal of emergency medicine · 2026Article
- Association between arterial to end-tidal carbon dioxide gradient and prehospital hemodynamic status in patients with moderate-to-severe traumatic brain injury.BMC emergency medicine · 2026Article
- Updates in Management of Acute Disorders of Consciousness After Traumatic Injury.Brain sciences · 2026Review
- A different perspective in trauma patients: can pan-immune-inflammation value (PIV) predict mortality?Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026Article
- Characterizing the impact of traumatic brain injury phenotype on coagulation dynamics in severely injured patients.Thrombosis research · 2026Article
- Development of a nomogram to predict in-hospital mortality of trauma patients in the ICU: an analysis of the MIMIC-IV database.Scientific reports · 2026Article
- Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: Report of the 2025 ISICEM roundtable.Intensive care medicine · 2026Review
- Multidimensional assessment of urinary dysfunction and quality of life after cervical cancer treatment: a multicenter study integrating urodynamics and patient-reported outcomes.Frontiers in oncology · 2026Article
- The Prognostic Value of Inflammatory Indexes in Patients With Severe Traumatic Brain Injury.Brain and behavior · 2025Article
- Comprehensive Review of Multidetector Computed Tomography (MDCT) in the Assessment of Blunt Cervical Spine Trauma in Adults.Journal of pharmacy & bioallied sciences · 2025Review
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
introductionEarly identification of traumatic brain injury followed by timely, targeted treatment is essential. We aimed to establish the ability of prehospital Glasgow Coma Scale score alone and combined with vital signs to predict hospital-diagnosed traumatic brain injury.
methodsThis study included adults from the 2017-2020 Trauma Quality Improvement Program data set with blunt mechanism. We calculated test characteristics of prehospital Glasgow Coma Scale score ≤12 alone and Glasgow Coma Scale score combined with heart rate and systolic blood pressure for predicting (1) any traumatic brain injury and (2) moderate to severe traumatic brain injury. Diagnostic performances were calculated in all patients and older adults (≥55 years). We used decision curve analysis to determine the net diagnostic benefit of prehospital Glasgow Coma Scale score combined with heart rate + systolic blood pressure over Glasgow Coma Scale score alone.
resultsOf 1,687,336 patients, 39.1% had any traumatic brain injury, 3.7% had moderate to severe traumatic brain injury, and 9.1% had a prehospital Glasgow Coma Scale score ≤12. Prehospital Glasgow Coma Scale score ≤12 alone had a sensitivity 83.1%, specificity 93.7%, negative predictive value 99.3%, and positive predictive value 33.7% for predicting moderate to severe traumatic brain injury. Adding prehospital heart rate <65/min and systolic blood pressure >150 mm Hg to Glasgow Coma Scale score ≤12 improved the positive predictive value for moderate to severe traumatic brain injury (55.3%), with a preserved negative predictive value of 96.4%. Decision curve analysis showed the traumatic brain injury prediction model including prehospital heart rate and systolic blood pressure had the greatest net benefit across most threshold probabilities.
conclusionLess than a third of adult blunt trauma patients with a prehospital Glasgow Coma Scale score ≤12 have moderate to severe traumatic brain injury. Supplementing Glasgow Coma Scale score with prehospital vital signs improves diagnostic accuracy, potentially by filtering out patients with altered consciousness due to shock. Future work should better identify patients for traumatic brain injury-specific treatments in prehospital settings, including triage destination.
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