Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale
Background The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Scor...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2024-10, Vol.50 (5), p.2491-2499 |
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| creator | Komboz, Fares Chehade, Hiba Douja Al Saffar, Bilal Mielke, Dorothee Rohde, Veit Abboud, Tammam |
| description | Background
The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Score (HS), a novel tool designed to incorporate radiological data, offers a promising approach to predicting TBI outcomes. This study aims to evaluate the prognostic efficacy of HS in comparison to GCS across a substantial TBI patient cohort.
Methods
This retrospective study encompassed TBI patients treated at our institution between 2008 and 2019, specifically those with an admission GCS of 14 or lower. We assessed both the initial GCS and the HS derived from primary CT scans. Key outcome metrics included the Glasgow Outcome Scale (GOS) and mortality rates at hospital discharge and at 6 and 12-month intervals post-discharge. Predictive performances of GCS and HS were analyzed through Receiver Operating Characteristic (ROC) curves and Kendall tau-b correlation coefficients against each outcome.
Results
The study included 544 patients, with an average age of 62.2 ± 21.5 years, median initial GCS of 14, and a median HS of 3. The mortality rate at discharge stood at 8.6%, with a median GOS of 4. Both GCS and HS demonstrated significant correlations with mortality and GOS outcomes (
p
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| doi_str_mv | 10.1007/s00068-024-02604-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3084772940</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3084772940</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-555008212c3c586d4fcc95bb11a5834e68abd6a07c66f79b68f58b1ced2a3fcc3</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMoWqt_wIMEvHhZnSSbbNabFL-g4EW9hmyaLVv3o2Z2Lf57o60VPAgTZsI875vwEnLC4IIBZJcIAEonwNN4FKTJaoeMmFYiyfOU7W5nIQ7IIeIi0qAk3ycHIgfJY43IyzWiR6zaOe2G3nWNR1q1tA92aGxfOVoEG-9VuxjCxxW993VkXyuKrguevvuAA9K72uK8W9Eot3Fja39E9kpboz_e9DF5vr15mtwn08e7h8n1NHGCqz6RUgJozrgTTmo1S0vnclkUjFmpReqVtsVMWcicUmWWF0qXUhfM-Rm3IrJiTM7XvsvQvQ0ee9NU6Hxd29Z3AxoBOs0ynqcQ0bM_6KIbQht_ZwQTAtIsz0Sk-JpyoUMMvjTLUDU2fBgG5it1s07dxNTNd-pmFUWnG-uhaPxsK_mJOQJiDWBctXMfft_-x_YTNHaNxQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3133047973</pqid></control><display><type>article</type><title>Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Komboz, Fares ; Chehade, Hiba Douja ; Al Saffar, Bilal ; Mielke, Dorothee ; Rohde, Veit ; Abboud, Tammam</creator><creatorcontrib>Komboz, Fares ; Chehade, Hiba Douja ; Al Saffar, Bilal ; Mielke, Dorothee ; Rohde, Veit ; Abboud, Tammam</creatorcontrib><description>Background
The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Score (HS), a novel tool designed to incorporate radiological data, offers a promising approach to predicting TBI outcomes. This study aims to evaluate the prognostic efficacy of HS in comparison to GCS across a substantial TBI patient cohort.
Methods
This retrospective study encompassed TBI patients treated at our institution between 2008 and 2019, specifically those with an admission GCS of 14 or lower. We assessed both the initial GCS and the HS derived from primary CT scans. Key outcome metrics included the Glasgow Outcome Scale (GOS) and mortality rates at hospital discharge and at 6 and 12-month intervals post-discharge. Predictive performances of GCS and HS were analyzed through Receiver Operating Characteristic (ROC) curves and Kendall tau-b correlation coefficients against each outcome.
Results
The study included 544 patients, with an average age of 62.2 ± 21.5 years, median initial GCS of 14, and a median HS of 3. The mortality rate at discharge stood at 8.6%, with a median GOS of 4. Both GCS and HS demonstrated significant correlations with mortality and GOS outcomes (
p
< 0.05). Notably, HS showed a markedly superior correlation with mortality (τb = 0.36) compared to GCS (τb = -0.11) and with GOS outcomes (τb = -0.40 for HS vs. τb = 0.33 for GCS). ROC analyses affirmed HS’s enhanced predictive accuracy over GCS for both mortality (AUC of 0.79 for HS vs. 0.62 for GCS) and overall outcomes (AUC of 0.77 for HS vs. 0.71 for GCS).
Conclusion
The findings validate the HS in a large German cohort and suggest that radiological assessments alone, as exemplified by HS, can surpass the traditional GCS in predicting TBI outcomes. However, the HS, despite its efficacy, lacks the integration of clinical evaluation, a vital component in TBI management. This underscores the necessity for a holistic approach that amalgamates both radiological and clinical insights for a more comprehensive and accurate prognostication in TBI care.</description><identifier>ISSN: 1863-9933</identifier><identifier>ISSN: 1863-9941</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-024-02604-w</identifier><identifier>PMID: 39052052</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Brain Injuries, Traumatic - diagnosis ; Brain Injuries, Traumatic - diagnostic imaging ; Brain Injuries, Traumatic - mortality ; Brain Injuries, Traumatic - therapy ; Critical Care Medicine ; Emergency Medicine ; Female ; Glasgow Coma Scale ; Humans ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Original Article ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; ROC Curve ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Tomography, X-Ray Computed ; Traumatic brain injury ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2024-10, Vol.50 (5), p.2491-2499</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-555008212c3c586d4fcc95bb11a5834e68abd6a07c66f79b68f58b1ced2a3fcc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-024-02604-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-024-02604-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39052052$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Komboz, Fares</creatorcontrib><creatorcontrib>Chehade, Hiba Douja</creatorcontrib><creatorcontrib>Al Saffar, Bilal</creatorcontrib><creatorcontrib>Mielke, Dorothee</creatorcontrib><creatorcontrib>Rohde, Veit</creatorcontrib><creatorcontrib>Abboud, Tammam</creatorcontrib><title>Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Background
The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Score (HS), a novel tool designed to incorporate radiological data, offers a promising approach to predicting TBI outcomes. This study aims to evaluate the prognostic efficacy of HS in comparison to GCS across a substantial TBI patient cohort.
Methods
This retrospective study encompassed TBI patients treated at our institution between 2008 and 2019, specifically those with an admission GCS of 14 or lower. We assessed both the initial GCS and the HS derived from primary CT scans. Key outcome metrics included the Glasgow Outcome Scale (GOS) and mortality rates at hospital discharge and at 6 and 12-month intervals post-discharge. Predictive performances of GCS and HS were analyzed through Receiver Operating Characteristic (ROC) curves and Kendall tau-b correlation coefficients against each outcome.
Results
The study included 544 patients, with an average age of 62.2 ± 21.5 years, median initial GCS of 14, and a median HS of 3. The mortality rate at discharge stood at 8.6%, with a median GOS of 4. Both GCS and HS demonstrated significant correlations with mortality and GOS outcomes (
p
< 0.05). Notably, HS showed a markedly superior correlation with mortality (τb = 0.36) compared to GCS (τb = -0.11) and with GOS outcomes (τb = -0.40 for HS vs. τb = 0.33 for GCS). ROC analyses affirmed HS’s enhanced predictive accuracy over GCS for both mortality (AUC of 0.79 for HS vs. 0.62 for GCS) and overall outcomes (AUC of 0.77 for HS vs. 0.71 for GCS).
Conclusion
The findings validate the HS in a large German cohort and suggest that radiological assessments alone, as exemplified by HS, can surpass the traditional GCS in predicting TBI outcomes. However, the HS, despite its efficacy, lacks the integration of clinical evaluation, a vital component in TBI management. This underscores the necessity for a holistic approach that amalgamates both radiological and clinical insights for a more comprehensive and accurate prognostication in TBI care.</description><subject>Adult</subject><subject>Aged</subject><subject>Brain Injuries, Traumatic - diagnosis</subject><subject>Brain Injuries, Traumatic - diagnostic imaging</subject><subject>Brain Injuries, Traumatic - mortality</subject><subject>Brain Injuries, Traumatic - therapy</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tomography, X-Ray Computed</subject><subject>Traumatic brain injury</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMoWqt_wIMEvHhZnSSbbNabFL-g4EW9hmyaLVv3o2Z2Lf57o60VPAgTZsI875vwEnLC4IIBZJcIAEonwNN4FKTJaoeMmFYiyfOU7W5nIQ7IIeIi0qAk3ycHIgfJY43IyzWiR6zaOe2G3nWNR1q1tA92aGxfOVoEG-9VuxjCxxW993VkXyuKrguevvuAA9K72uK8W9Eot3Fja39E9kpboz_e9DF5vr15mtwn08e7h8n1NHGCqz6RUgJozrgTTmo1S0vnclkUjFmpReqVtsVMWcicUmWWF0qXUhfM-Rm3IrJiTM7XvsvQvQ0ee9NU6Hxd29Z3AxoBOs0ynqcQ0bM_6KIbQht_ZwQTAtIsz0Sk-JpyoUMMvjTLUDU2fBgG5it1s07dxNTNd-pmFUWnG-uhaPxsK_mJOQJiDWBctXMfft_-x_YTNHaNxQ</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Komboz, Fares</creator><creator>Chehade, Hiba Douja</creator><creator>Al Saffar, Bilal</creator><creator>Mielke, Dorothee</creator><creator>Rohde, Veit</creator><creator>Abboud, Tammam</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20241001</creationdate><title>Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale</title><author>Komboz, Fares ; Chehade, Hiba Douja ; Al Saffar, Bilal ; Mielke, Dorothee ; Rohde, Veit ; Abboud, Tammam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-555008212c3c586d4fcc95bb11a5834e68abd6a07c66f79b68f58b1ced2a3fcc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Brain Injuries, Traumatic - diagnosis</topic><topic>Brain Injuries, Traumatic - diagnostic imaging</topic><topic>Brain Injuries, Traumatic - mortality</topic><topic>Brain Injuries, Traumatic - therapy</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Tomography, X-Ray Computed</topic><topic>Traumatic brain injury</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Komboz, Fares</creatorcontrib><creatorcontrib>Chehade, Hiba Douja</creatorcontrib><creatorcontrib>Al Saffar, Bilal</creatorcontrib><creatorcontrib>Mielke, Dorothee</creatorcontrib><creatorcontrib>Rohde, Veit</creatorcontrib><creatorcontrib>Abboud, Tammam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Komboz, Fares</au><au>Chehade, Hiba Douja</au><au>Al Saffar, Bilal</au><au>Mielke, Dorothee</au><au>Rohde, Veit</au><au>Abboud, Tammam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>50</volume><issue>5</issue><spage>2491</spage><epage>2499</epage><pages>2491-2499</pages><issn>1863-9933</issn><issn>1863-9941</issn><eissn>1863-9941</eissn><abstract>Background
The precision of assessment and prognosis in traumatic brain injury (TBI) is paramount for effective triage and informed therapeutic strategies. While the Glasgow Coma Scale (GCS) remains the cornerstone for TBI evaluation, it overlooks critical primary imaging findings. The Helsinki Score (HS), a novel tool designed to incorporate radiological data, offers a promising approach to predicting TBI outcomes. This study aims to evaluate the prognostic efficacy of HS in comparison to GCS across a substantial TBI patient cohort.
Methods
This retrospective study encompassed TBI patients treated at our institution between 2008 and 2019, specifically those with an admission GCS of 14 or lower. We assessed both the initial GCS and the HS derived from primary CT scans. Key outcome metrics included the Glasgow Outcome Scale (GOS) and mortality rates at hospital discharge and at 6 and 12-month intervals post-discharge. Predictive performances of GCS and HS were analyzed through Receiver Operating Characteristic (ROC) curves and Kendall tau-b correlation coefficients against each outcome.
Results
The study included 544 patients, with an average age of 62.2 ± 21.5 years, median initial GCS of 14, and a median HS of 3. The mortality rate at discharge stood at 8.6%, with a median GOS of 4. Both GCS and HS demonstrated significant correlations with mortality and GOS outcomes (
p
< 0.05). Notably, HS showed a markedly superior correlation with mortality (τb = 0.36) compared to GCS (τb = -0.11) and with GOS outcomes (τb = -0.40 for HS vs. τb = 0.33 for GCS). ROC analyses affirmed HS’s enhanced predictive accuracy over GCS for both mortality (AUC of 0.79 for HS vs. 0.62 for GCS) and overall outcomes (AUC of 0.77 for HS vs. 0.71 for GCS).
Conclusion
The findings validate the HS in a large German cohort and suggest that radiological assessments alone, as exemplified by HS, can surpass the traditional GCS in predicting TBI outcomes. However, the HS, despite its efficacy, lacks the integration of clinical evaluation, a vital component in TBI management. This underscores the necessity for a holistic approach that amalgamates both radiological and clinical insights for a more comprehensive and accurate prognostication in TBI care.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39052052</pmid><doi>10.1007/s00068-024-02604-w</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Brain Injuries, Traumatic - diagnosis Brain Injuries, Traumatic - diagnostic imaging Brain Injuries, Traumatic - mortality Brain Injuries, Traumatic - therapy Critical Care Medicine Emergency Medicine Female Glasgow Coma Scale Humans Intensive Male Medicine Medicine & Public Health Middle Aged Mortality Original Article Predictive Value of Tests Prognosis Retrospective Studies ROC Curve Sports Medicine Surgery Surgical Orthopedics Tomography, X-Ray Computed Traumatic brain injury Traumatic Surgery |
| title | Assessing outcomes in traumatic brain injury: Helsinki score versus Glasgow coma scale |
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