ArticleNeurosurgical review2025
The impact of glasgow outcome scale - extended cut-point of dichotomization on factors associated with outcomes in traumatic brain injury research.
Article in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This study delves into the challenges of dichotomizing Glasgow Outcome Scale Extended (GOSE) scores in Traumatic Brain Injury (TBI) research, aiming to elucidate predictors of outcome across various cut-points. This retrospective cohort study utilized registry data of TBI patients admitted a level 1 trauma center. Data extracted encompassed demographic details, TBI mechanism, neurologic examinations, clinical assessments, lab results, neuroimaging findings, procedures performed, Intensive Care Unit (ICU) length of stay, and GOSE at discharge. Unfavorable and favorable outcomes were determined using GOSE scores below (unfavorable) and equal or above (favorable) specific cut-points (4, 5, 6, and 7). Outcomes were investigated in the entire TBI population and also, specifically among the survivors. Univariate analyses were conducted along with multivariate logistic regression to identify factors independently associated with outcomes. The study sample predominantly consisted of male patients (83.8%) with a median age of 37 years. Age, GSC score, pupillary light reflex, Intra Ventricular Hemorrhage (IVH), the need for tracheostomy, and ICU length of stay were found to be significant factors in predicting outcomes for both the overall TBI population and TBI survivors, across all cut-points. In particular, Subarachnoid Hemorrhage (SAH), midline shift > 5 mm, and the need for Decompressive Craniectomy (DC) were identified as predictors in the cut-point of 7 (good recovery vs. poorer outcomes). Interestingly, factors such as International Normalized Ratio (INR), and hemoglobin level (Hb) were significant predictors of outcomes when investigating the entire TBI population; however, they did not show significant discriminatory power in predicting level of functional independency for TBI survivors. In conclusion, this study highlights the complexity of predicting outcomes in traumatic brain injury patients using the GOSE and various cut-points. These results contribute to a better understanding of recovery trajectories and prognostic factors in TBI patients.
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