Abstract

BackgroundThe Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients.MethodsUsing the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation.ResultsA total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871–0.878) and 0.878 (0.874–0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category.ConclusionsJCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

Highlights

  • The Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan

  • We examined ability to accurately predict outcomes based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis, focusing on JCS and Glasgow Coma Scale (GCS) scores

  • When we focused on the simple four-point scale JCS score (0, one-digit, two-digit, and three-digit scores), the adjusted odds ratios (ORs) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS score of 0 as a reference category

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Summary

Introduction

The Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. The Glasgow Coma Scale (GCS) has been widely utilized to evaluate consciousness level in a variety of clinical settings, including trauma care [1,2,3,4]. In Japan, the Japan Coma Scale (JCS) is the most extensively adopted scale for assessing patients’ consciousness level because of its simplicity and applicability [10, 11]. Previous studies have indicated that JCS score correlates with outcomes

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