Association of GKS, GOS, ISS and RTS Scoring with Prognosis in Patients with Traumatic Brain Injury

Yıl 2025, Cilt: 9 Sayı: 3, 360 - 366, 22.12.2025

Canan Şahin

https://doi.org/10.46332/aemj.1729356

Öz

Purpose: To evaluate the relationship between Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) with prognosis in patients diagnosed with traumatic brain injury (TBI).

Materials and Methods: The study design was retrospective. A total of 260 patients aged 18 years and older with pathological findings on brain computed tomography (CT) after head trauma were included in the study. Demographic characteristics, trauma mechanism, CT findings, GCS, ISS, RTS scores, and neurological outcomes were evaluated.

Results: Of the patients, 83.1% were male and 60.4% were aged between 18-45 years. Mild TBI was observed in 48.5%, moderate in 26.2%, and severe in 25.4% of cases. The mean age of deceased patients was 47.8±20.2 years, significantly higher than survivors (42±16.9 years, p<0.05). Diffuse cerebral edema (44.4% vs. 14.4%), subarachnoid hemorrhage (48.6% vs. 26.1%), and multiple contusions (51.4% vs. 36.7%) were significantly more common in deceased patients (p<0.05). Poor neurological outcome was detected in 90.9% of patients with GCS ≤8, while 92.1% of those with GCS 14-15 had good outcomes (p<0.05). The mean ISS was 14.39±8.39 in the good outcome group and 35.75±9.71 in the poor outcome group (p<0.05). The mean RTS was 7.54±0.55 and 5.13±1.83, respectively (p<0.05).

Conclusion: Low GCS, high ISS, low RTS, and certain BBT findings are thought to be associated with poor neurological outcomes in TBH patients.

Anahtar Kelimeler

emergency departmen , trauma scoring systems , traumatic brain injury

Etik Beyan

Bu çalışma için Ondokuz Mayıs Üniversitesi Tıbbi Araştırma Etik Komisyonundan onay alındı (26.01.2012 tarihli ve 2012/519 sayılı) .

Travmatı̇k Beyı̇n Hasarı Olan Hastalarda GKS, GOS, ISS ve RTS Skorlamalarının Prognozla İlı̇şkı̇sı̇

Öz

Amaç: Bu çalışmada, travmatik beyin hasarı (TBH) tanısı alan hastalarda Glasgow Koma Skalası (GKS), Glasgow Sonuç Skalası (GOS), Yaralanma Şiddet Skoru (ISS) ve Revize Travma Skoru (RTS) ile prognoz arasındaki ilişkiyi değerlendirmek amaçlanmıştır.

Araçlar ve Yöntem: Çalışma tasarımı retrospektif tipte yapılmıştır. Kafa travması sonrası beyin bilgisayarlı tomografisinde (BBT) patolojik bulguları olan 18 yaş ve üstü 260 hasta çalışmaya dahil edilmiştir. Demografik özellikler, travma mekanizması, BBT bulguları, GKS, ISS, RTS skorları ve nörolojik sonuçlar ile birlikte değerlendirilmiştir.

Bulgular: Hastaların %83.1'i erkek ve %60.4'ü 18-45 yaş arasındaydı. Olguların %48.5'inde hafif, %26.2'sinde orta ve %25.4'ünde ağır TBH gözlendi. Ölen hastaların yaş ortalaması 47.8±20.2 yıl olup sağ kalanlara göre anlamlı derecede yüksektir (42±16.9 yıl, p<0.05). Ölen hastalarda yaygın serebral ödem (%44.4'e karşı %14.4), subaraknoid kanama (%48.6'ya karşı %26.1) ve çoklu kontüzyon (%51.4'e karşı %36.7) anlamlı olarak daha yaygındı (p<0.05). GKS ≤8 olan hastaların %90.9'unda kötü nörolojik sonuç saptanırken, GKS 14-15 olanların %92.1'inde iyi sonuç elde edildi (p<0.05). Ortalama ISS iyi sonuç grubunda 14.39±8.39 iken kötü sonuç grubunda 35.75±9.71 idi (p<0.05). Ortalama RTS sırasıyla 7.54±0.55 ve 5.13±1.83 idi (p<0.05).

Sonuç: Düşük GKS, yüksek ISS, düşük RTS ve bazı BBT bulguları TBH hastalarında kötü nörolojik sonuçlarla ilişkili olduğu
düşünülmektedir.

Anahtar Kelimeler

acil servis , travma skorlama sistemler , travmatik beyin hasarı

Etik Beyan

Ethical approval for this study was obtained from the Ondokuz Mayıs University Medical Research Ethics Committee (dated January 26, 2012, and numbered 2012/519).

Kaynakça

• 1. Stein D, Broderick M. Management of head trauma. Surg Clin North Am. 2024;104(2):325–341.
• 2. Peterson AB, Thomas KE. Incidence of nonfatal traumatic brain injury-related hospitalizations – United States, 2018. MMWR Morb Mortal Wkly Rep. 2021;70(48):1664–1668.
• 3. Wright DW, Merck LH. Head trauma in adults and children. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020:1683–1695.
• 4. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480–484.
• 5. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35(4):347–358.
• 6. Moore L, Lavoie A, Abdous B, et al. Unification of the revised trauma score. J Trauma. 2006;61(3):718–722.
• 7. Rosen CB, Luy DD, Deane MR, Scalea TM, Stein DM. Routine repeat head CT may not be necessary for patients with mild TBI. Trauma Surg Acute Care Open. 2018;3(1):129.
• 8. Jeong TS, Choi DH, Kim WK; Korea Neuro-Trauma Data Bank (KNTDB) Investigators. The relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury. Korean J Neurotrauma. 2022;18(2):169–177.
• 9. Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136(10):1118–1123.
• 10. Tseng WC, Shih HM, Su YC, Chen HW, Hsiao KY, Chen IC. The association between skull bone fractures and outcomes in patients with severe traumatic brain injury. J Trauma. 2011;71(6):1611–1614.
• 11. Chamoun RB, Robertson CS, Gopinath SP. Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation. J Neurosurg. 2009;111(4):683–687.
• 12. Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923–929.
• 13. Cadotte DW, Vachhrajani S, Pirouzmand F. The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007. J Neurosurg. 2011;114(6):1502–1509.
• 14. Sogut O, Guloglu C, Orak M, et al. Trauma scores and neuron-specific enolase, cytokine and C-reactive protein levels as predictors of mortality in patients with blunt head trauma. J Int Med Res. 2010;38(5):1708–1720.
• 15. Bahloul M, Chelly H, Ben Hmida M, et al. Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma. 2004;57(2):255–261.
• 16. Bahloul M, Chaari A, Chabchoub I, et al. Outcome analysis and outcome predictors of traumatic head injury in childhood: analysis of 454 observations. J Emerg Trauma Shock. 2011;4(2):198–206.
• 17. Timmons SD, Bee T, Webb S, Diaz-Arrastia RR, Hesdorffer D. Using the abbreviated injury severity and Glasgow Coma Scale scores to predict 2-week mortality after traumatic brain injury. J Trauma. 2011;71(5):1172–1177.