Validation of the GCS-pupil scale in traumatic brain injury: incremental prognostic value of pupillary reactivity with GCS in the prospective observational cohorts CENTER-TBI and TRACK-TBI

Vreeburg, R.J.G.; Leeuwen, F.D. van; Manley, G.T.; Yue, J.K.; Brennan, P.M.; Sun, X.Y.; Jain, S.; Essen, T.A. van; Peul, W.C.; Maas, A.I.R.; Menon, D.K.; Steyerberg, E.W.; CENTER-TBI Participant &amp; Investigator; TRACK-TBI Participants &amp; Investigators; Natl Inst Neurological Disorders &amp; Stroke Initiative Classification

doi:doi:10.1089/neu.2024.0458

Persistent URL of this record https://hdl.handle.net/1887/4283227

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Medicine / Leiden University Medical Centre (LUMC)

Vreeburg, R.J.G.; Leeuwen, F.D. van; Manley, G.T.; Yue, J.K.; Brennan, P.M.; Sun, X.Y.; ... ; Natl Inst Neurological Disorders & Stroke Initiative Classification (2024)

Validation of the GCS-pupil scale in traumatic brain injury: incremental prognostic value of pupillary reactivity with GCS in the prospective observational cohorts CENTER-TBI and TRACK-TBI

Article / Letter to editor

To compare the incremental prognostic value of pupillary reactivity captured as part of the Glasgow Coma Scale–Pupils (GCS–P) score or added as separate variable to the GCS+P, in traumatic brain injury (TBI). We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n = 3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n = 1439) cohorts. Logistic regression was utilized to quantify the prognostic performances of GCS–P (GCS minus number of unreactive pupils) and GCS+P versus GCS alone according to Nagelkerke’s R². End-points were mortality and unfavorable outcome (Glasgow Outcome Scale–Extended score 1–4) at 6 month post-injury. We estimated 95% confidence intervals (CIs) with bootstrap resampling to summarize the improvement in prognostic capability. In a meta-analysis of CENTER-TBI and TRACK-TBI,...Show more To compare the incremental prognostic value of pupillary reactivity captured as part of the Glasgow Coma Scale–Pupils (GCS–P) score or added as separate variable to the GCS+P, in traumatic brain injury (TBI). We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n = 3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n = 1439) cohorts. Logistic regression was utilized to quantify the prognostic performances of GCS–P (GCS minus number of unreactive pupils) and GCS+P versus GCS alone according to Nagelkerke’s R². End-points were mortality and unfavorable outcome (Glasgow Outcome Scale–Extended score 1–4) at 6 month post-injury. We estimated 95% confidence intervals (CIs) with bootstrap resampling to summarize the improvement in prognostic capability. In a meta-analysis of CENTER-TBI and TRACK-TBI, GCS as a linear score had a R² of 25% (95% CI 19–31%) for mortality and 33% (4–41%) for unfavorable outcome. Pupillary reactivity as a separate variable improved the R² by an absolute value of 6% (4.0–7.7%) and 2% (1.2–3.0%) for mortality and unfavorable outcome, respectively, while comparatively half of this improvement was captured by the GCS–P score (3% [2.1–3.3%], 1% [1–1.7%], respectively). GCS–P showed a stronger association with 6-month outcome after TBI than GCS alone and provides a single integrated score. However, this comes at a loss of clinical and prognostic information compared with GCS+P. For prognostic models, inclusion of GCS and pupillary reactivity as separate factors may be preferable to using a GCS–P summary score.
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