Cristina Helena Costanti Settervall

In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

El estudio tiene como objetivos verificar y comparar el desempeno de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos despues de la atencion inicial intra-hospitalaria, ademas de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de prediccion de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 victimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeno de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las areas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la practica clinica para estimar el pronostico de las victimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scales predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instruments moderate discriminatory power.

Escala de coma de Glasgow e qualidade de vida pós-trauma cranioencefálico

Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Performance of Trauma and Injury Severity Score(TRISS) adjustments: an integrative review

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Glasgow Coma Scale and quality of life after traumatic brain injury

Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.

Escala de Coma de Glasgow en las primeras 72 horas postrauma encefalocraneano y mortalidad hospitalaria

El estudio tiene como objetivos verificar y comparar el desempeno de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos despues de la atencion inicial intra-hospitalaria, ademas de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de prediccion de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 victimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeno de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las areas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la practica clinica para estimar el pronostico de las victimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scales predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instruments moderate discriminatory power.

Rendimiento de los ajustes de Trauma and Injury Severity Score (TRISS): revisión integrativa

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

The use of severity indexes to estimate the risk of death in Intensive Care

The Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) are instruments used to classify Intensive Care Unit (ICU) inpatients according to the severity of their condition and risk of death, and evaluate the quality of nursing care. The objective of this study is to evaluate and compare the performance of SAPS II and LODS to predict the mortality of patients admitted to the ICU. The participants were 600 patients from four ICUs located in Sao Paulo, Brazil. Receiver Operator Characteristic (ROC) curves were used to compare the performance of the indexes. Results: The areas under the ROC curves of LODS (0.69) and SAPS II (0.71) indicated moderate discriminatory capacity to identify death or survival. No statistically significant differences were found between these areas (p=0.26). In conclusion, there was equivalence between SAPS II and LODS to estimate the risk of death of ICU patients.UNLABELLED The Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) are instruments used to classify Intensive Care Unit (ICU) inpatients according to the severity of their condition and risk of death, and evaluate the quality of nursing care. The objective of this study is to evaluate and compare the performance of SAPS II and LODS to predict the mortality of patients admitted to the ICU. The participants were 600 patients from four ICUs located in São Paulo, Brazil. Receiver Operator Characteristic (ROC) curves were used to compare the performance of the indexes. RESULTS The areas under the ROC curves of LODS (0.69) and SAPS II (0.71) indicated moderate discriminatory capacity to identify death or survival. No statistically significant differences were found between these areas (p=0.26). In conclusion, there was equivalence between SAPS II and LODS to estimate the risk of death of ICU patients.

Desempeño de índices de gravedad para estimar riesgo de muerte en Unidades de Terapia Intensiva

The Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) are instruments used to classify Intensive Care Unit (ICU) inpatients according to the severity of their condition and risk of death, and evaluate the quality of nursing care. The objective of this study is to evaluate and compare the performance of SAPS II and LODS to predict the mortality of patients admitted to the ICU. The participants were 600 patients from four ICUs located in Sao Paulo, Brazil. Receiver Operator Characteristic (ROC) curves were used to compare the performance of the indexes. Results: The areas under the ROC curves of LODS (0.69) and SAPS II (0.71) indicated moderate discriminatory capacity to identify death or survival. No statistically significant differences were found between these areas (p=0.26). In conclusion, there was equivalence between SAPS II and LODS to estimate the risk of death of ICU patients.UNLABELLED The Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) are instruments used to classify Intensive Care Unit (ICU) inpatients according to the severity of their condition and risk of death, and evaluate the quality of nursing care. The objective of this study is to evaluate and compare the performance of SAPS II and LODS to predict the mortality of patients admitted to the ICU. The participants were 600 patients from four ICUs located in São Paulo, Brazil. Receiver Operator Characteristic (ROC) curves were used to compare the performance of the indexes. RESULTS The areas under the ROC curves of LODS (0.69) and SAPS II (0.71) indicated moderate discriminatory capacity to identify death or survival. No statistically significant differences were found between these areas (p=0.26). In conclusion, there was equivalence between SAPS II and LODS to estimate the risk of death of ICU patients.

Escala de coma de Glasgow y calidad de vida post-trauma craneoencefálico

Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.Objective: To evaluate the behavior of different scores on the Glasgow Coma Scale (GCS) observed during the first 72 hours after trauma, before the perceived changes to quality of life and health status, and one year after the traumatic event. Methods: A study using a quantitative approach, observational, longitudinal, descriptive and correlational with victims of blunt head trauma (BHT) evaluated daily during hospitalization, and after one year by means of the Medical Outcome Study 36-Item Short Form Health Survey (SF -36). Results: Under the Reciever Operator Characteristic curves, the values of the GCS related to the perceived change of health status did not differ significantly and ranged from 0.63 to 0.71. A correlation, statistically significant, although weak, was observed between GCS scores and some of the domains of the SF-36. Conclusion: It was found that the different values of the GCS presented limitations for application in clinical practice for estimating the consequences of long term BHT.