Modified Glasgow Coma Scale Score Research Articles

Factors influencing spontaneous hypothermia after emergency trauma and the construction of a predictive model.

This study aimed to investigate spontaneous hypothermia among emergency trauma patients and develop a predictive model. A cohort of 162 emergency trauma patients was categorized into hypothermic (n = 61) and control (n = 101) groups, with trauma severity assessed using the modified Glasgow Coma Scale (GCS). Univariate analysis revealed significant differences between the groups in trauma severity, posture, garment wetness, warming measures, pre-hospital fluid resuscitation, and modified GCS scores (P < 0.05). The hypothermic group exhibited lower prothrombin time compared to the control group (P < 0.05). A logistic regression model was constructed, expressed as Y = 25.76 - 1.030X 1 + 0.725X 2 + 0.922X 3 - 0.750X 4 - 0.57X 6, and its fit was evaluated using the Hosmer-Lemeshow test. The receiver operating characteristic curve demonstrated an area under the curve of 0.871, with 81.2% sensitivity and 79.5% specificity. The Youden index identified the optimal predictive cut-off at its highest (0.58). Validation results included 86.21% sensitivity, 82.93% specificity, and 84.29% accuracy. Risk factors for spontaneous hypothermia after emergency trauma encompassed trauma severity, posture during consultation, clothing dampness upon admission, warming measures during transfer, pre-hospital fluid resuscitation, and modified GCS scores. The risk prediction model demonstrated high accuracy, enabling effective assessment of spontaneous hypothermia risk in emergency trauma patients and facilitating preventive measures.

An avian Modified Glasgow Coma Scale as a prognostic indicator in raptors with head trauma.

To develop a Modified Glasgow Coma Scale (MGCS) for use in raptors presenting with head trauma and assess the agreement of the MGCS scores between examiners with varying backgrounds, and to assess the prognostic value of the avian MGCS in raptors with head trauma. 156 native raptorial species. All raptors received an MGCS assessment within 8 hours of their presentation, between January 1, 2018, and December 31, 2019. For the first objective, the assessment was performed by a veterinary student, a wildlife veterinarian, and a board-certified or resident veterinary neurologist. Each animal received a score in 3 categories (motor activity, level of consciousness, and brain stem reflexes) and an overall score. For the second objective, the MGCS scoring was performed by the intaking clinical team member and survival after 48 hours was documented. Agreement between the 3 individual scores was assessed via Cronbach α and intraclass correlation. There was excellent-good agreement in all 3 assessment categories as well as the overall score. Univariate associations between survival and demographic factors were determined using the χ2 test. Overall, raptors with a total MGCS of < 10 were less likely to survive than those with a score > 12. An avian-specific MGCS demonstrated good-excellent agreement among raters of various backgrounds in assessing raptors with head trauma. Additionally, this study showed that an avian-specific MGCS may be correlated with the probability of survival within the first 48 hours after presentation to rehabilitation facilities in raptors with head trauma.

Surgical interventions and outcome in a population of feline trauma patients.

To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases. University teaching hospital. Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020. None. Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P<0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P<0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P=0.0553). No difference in modified Glasgow Coma Scale score was found between any groups. Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.

Relationship between admission vitals and brain herniation in 32 cats: a retrospective study.

The aim of the study was to evaluate whether any admission vitals correlated with the presence of brain herniation diagnosed via MRI in cats presenting with neurologic signs. Medical records at two veterinary university referral centers were reviewed to identify cats that underwent brain MRI between 2010 and 2019. A control group of cats with intracranial lesions without concurrent brain herniation was analyzed for comparison. Data relating to signalment, vitals on admission, abnormalities observed on initial neurologic examination, underlying etiology, advanced imaging findings and outcome were reviewed. A Modified Glasgow Coma Scale (MGCS) score was determined retrospectively based on initial neurologic examination. Logistic regressions were performed to investigate the relationship between each risk factor and the odds of brain herniation as diagnosed on MRI. Thirty-two cats with brain herniation and 44 cats with abnormal brain MRI without evidence of herniation (as a control group) based on MRI findings were included. Cats with intracranial neoplasia vs other diagnoses were found to be at increased risk of herniation (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.8-13.8; P = 0.001). The odds of herniation increased with age (OR 1.1, 95% CI 1.01-1.2; P = 0.031). Cats with herniation had a significantly lower level of consciousness in their MGCS score (P <0.0001) than cats without herniation. There was no significant difference in either motor activity or brainstem reflexes between the groups (P >0.05). Admission heart rate and blood pressure were not associated with brain herniation. Cats with herniation were presented with a significantly lower level of consciousness in their MGCS score; however, this clinical feature cannot be directly attributable to and predictive of herniation. Older cats with intracranial neoplasia are more likely to have brain herniation.

Retrospective evaluation of the relationship between admission variables and brain herniation in dogs (2010-2019): 54 cases.

To document the admission systolic blood pressure (SBP), heart rate (HR), and modified Glasgow coma scale (MGCS) score in dogs with and without brain herniation and to determine their relationship with brain herniation. Retrospective study between 2010 and 2019. University veterinary teaching hospital. Fifty-four client-owned dogs with brain herniation and 40 client-owned dogs as a control group, as determined on magnetic resonance imaging. None. SBP, HR, MGCS score, and outcome were extracted from medical records. MGCS score was retrospectively calculated based on initial neurological examination in dogs with adequate available information. Dogs with brain herniation had a significantly higher SBP (P=0.0078), greater SBP-HR difference (P=0.0006), and lower MGCS score (P<0.0001) compared to control dogs. A cutoff value of an SBP≥178 mm Hg, SBP-HR≥60, and MGCS score≤14 each provides a specificity of 90%-98%. A combination of an SBP>140 mm Hg and HR<80/min provided 24% sensitivity and 100% specificity to diagnose dogs with brain herniation (P<0.0001). A high SBP, a greater difference between SBP and HR, a combination of higher SBP and lower HR, and a low MGCS score were associated with brain herniation in dogs presenting with neurological signs upon admission. Early recognition of these abnormalities may help veterinarians to suspect brain herniation and determine timely treatment.

The prognostic value of admission point-of-care testing and modified Glasgow Coma Scale score in dogs and cats with traumatic brain injuries (2007-2010): 212 cases.

To investigate the association between admission point-of-care parameters and survival to discharge in dogs and cats with traumatic brain injury (TBI). Retrospective study 2007-2010. A rural university teaching hospital and an urban private practice teaching hospital. One hundred thirty-one dogs and 81 cats admitted to the emergency service with evidence of head injury based on history from the owner or physical exam. In dogs, nonsurvivors had significantly higher glucose concentrations at admission than survivors (median=8.49 mmol/L [153mg/dl] vs 6.83mmol/L [123mg/dl], p=0.039). In cats, there was no significant difference in admission glucose between survivors and nonsurvivors (median=10.21mmol/L [184mg/dl] vs 10.93mmol/L [197mg/dl], p=0.17). Modified Glasgow Coma Scale (MGCS) score was available for 105 of the 131 dogs (80%) and was significantly higher in survivors than in nonsurvivors (median=16 vs 11, p<0.0001). MGCS was available for 45 of the 81 cats (56%) and was significantly higher in survivors than in nonsurvivors (median=17vs 14, p=0.0005). The relative prognostic value of the admission point-of-care testing parameters and MGCS were assessed using a stepwise linear regression model, which included admission glucose, pH, base excess, sodium, and MGCS. In dogs, only admission glucose was an independent predictor of survival (odds ratio=1.027, 95% confidence interval, 1.0042-1.05, p=0.019). These results suggest that, as in people with TBI, increased blood glucose concentrations may have prognostic significance in dogs with TBI but not in cats. In addition, MGCS score may be predictive of survival in both dogs and cats with TBI.

Clinicoepidemiological profile and risk factors associated with mortality in traumatized cats admitted to a veterinary teaching hospital in Brazil.

The aim of this study was to evaluate possible risk factors for death in traumatized cats based on the clinicoepidemiological profile, the Animal Trauma Triage (ATT) scale score and the Modified Glasgow Coma Scale (MGCS) score at the time of presentation to the hospital. This was a cross-sectional study involving cats admitted to the emergency sector (ES) and the surgical clinic sector (SCS) of a veterinary teaching hospital (VTH) in northeastern Brazil over a 12-month period (2018-2019). Probable risk factors associated with non-survival after trauma were analyzed by calculating the prevalence ratio. The prediction of non-survival was evaluated by analyzing the receiver operating characteristic (ROC) curve employing the ATT scale score, MGCS score and rectal temperature. In 1 year, 89 traumatized cats were admitted to the VTH, of which 90% (n = 80) were young, 54% (n = 48) were male, 79% (n = 70) were intact, 59% (n = 53) were indoor cats and 92% (n = 82) were considered as mixed breed. Blunt trauma was the most prevalent cause of injuries, reported in 76% (n = 68) of the cats. Accidents involving falls (30%; n = 27) that affected the pelvic limbs (50.6%) were the most commonly reported. The prevalence of death among cats admitted to the ES was 9.44 times higher than that of animals treated at the SCS. Trauma as result of being run over and chest trauma were associated with a higher probability of death. Most of the animals that died had a lower rectal temperature than those that survived. The ATT scale score, MGCS score and rectal temperature were predictive of mortality. Rectal temperature, ATT scale score and MGCS score were effective predictors of an unfavorable prognosis and point to the need for emergency procedures. Hypothermia, being run over and chest trauma were associated with a higher risk of mortality. Our findings highlight the importance of prompt and effective care for these conditions.

Acute Salt Toxicity Caused by Whey Ingestion in Mixed-breed 6-months old Puppy: A case study

This case report aims to emphasize the acute management of a dog with suspected salt intoxication, which consists of a treatment protocol with hematological and Modified Glasgow Coma Scale (MGCS) changes and electrocardiographic (ECG) evaluation. A 6-month-old male mixed-breed dog was admitted to the emergency clinic with complaints of weakness, hypersalivation, vomiting, diarrhea and gait disturbance. It was learned from the owner that the dog was fed on whey for the first time on the morning of the admission day. Salt toxication was suspected based on history and clinical symptoms. The diagnosis was confirmed by laboratory analysis (pH: 7.185, Na: 178 mmol./L, Cl: 155 mmol./L, K: 8.3 mmol./L, HCO3: 16.1 mmol./L, BE: -8.8 mmol./L, BUN: 105.7 mg/dl, creatinine: 5.4 mg/dl, AST: 513 U/L, amylase: 2324 U/L, LDH: 794 U/L, calcium: 11.8 mg/dl, phosphorus: 13.9 mg/dl, cholesterol: 515 mg/dl, magnesium: 3.6 mg/dl, GGT: 62 U/L CPK: 450 U/L and CK-MB: 324.5 U/L), ECG (sinus tachycardia (180 bpm) and mild ST depression) and MGCS evaluation (pre-treatment score; 7, grave). A treatment protocol including fluid therapy, antiemetic, diuretic, anticonvulsant, beta-blocker to prevent sodium retention and oxygen therapy was administrated to the dog during the hospitalization period. It was observed that the clinical findings and MGCS score improved and some blood parameters returned to their reference range on Day 2. Since the dog died on Day 3 after the hospitalization period, which was terminated at the owner's request, it was concluded that an adequate hospitalization period is important. The presented treatment protocol with MGCS evaluation in salt toxicity was successful enough only in acute management.

Modified Glasgow Coma Scale and the Alert Verbal Painful Unresponsive Scale for Assessing the Level of Consciousness in Pediatric Critical Care Patients—A Comparative Study

AbstractAltered consciousness is a common problem encountered in the pediatric emergency department. Modified Glasgow coma scale (MGCS) has been widely used in pediatric intensive care units (PICUs) for assessing the level of consciousness in children with various illnesses. To compare utility of alert verbal painful unresponsive (AVPU) scale and MGCS for assessing level of consciousness of critically ill patients admitted to PICU. A prospective observational study was conducted at Acharya Vinoba Bhave Rural Hospital in Maharashtra, India on children above the age of 30 days admitted to the PICU from September 2018 to August 2019, fulfilling the inclusion criteria, after obtaining informed consent from the parents. Level of consciousness of the enrolled patients was assessed using the AVPU scale and MGCS. One-way analysis of variance technique was used for data analysis. A total of 74 children were included in the study. A good correlation was observed between the two scales and mean MGCS score of 13.8 (13–15), 11.3 (11–12), 8.09 (7–9), and 3 corresponded to A, V, P, and U, respectively. AVPU scale was comparable to MGCS in assessing level of consciousness in children admitted to PICU. AVPU can be used for initial evaluation of level of consciousness in children presenting with altered consciousness. More detailed MGCS can be used to assess the improvement over time and to decide further treatment strategy.

Correlation between bispectral index value and modified Glasgow Coma Scale score in dogs with altered level of consciousness.

This study aims to identify the correlation between bispectral index (BIS) value and modified Glasgow Coma Scale (MGCS) score in dogs with altered level of consciousness (ALOC). This prospective, observational, clinical study was conducted from February 2016 to March 2017, and follow-up was conducted until the death of dogs or their discharge from the hospital. This study was performed at the Small Animal Teaching Hospital. A total of 31 client-owned dogs (males, 20; females, 11) with ALOC and MGCS score<18 with no restrictions for age, breed, sex, and body weight were included. Dogs that received neuromuscular blocking agents before MGCS score evaluation were excluded. BIS values were measured using the Covidien BIS Loc 2 Channel OEM module and a pediatric 4 sensor with a bifrontal application pattern. Minimal databases of initial neurological assessment, blood profiles, and chest and skull radiographs were developed. In addition, MGCS scores and BIS values were recorded. The mean BIS values for mild, moderate, and severe brain injuries were 89.14 ± 6.52, 77.21 ± 9.82, and 50.58 ± 27.04, respectively. Correlation analysis revealed a significantly positive relationship between BIS values and MGCS scores (r=0.75; P<0.001). The significant correlation observed between MGCS scores and BIS values in dogs with ALOC demonstrated the usefulness of BIS as an alternative to MGCS for monitoring consciousness in patients with ALOC caused by traumatic brain injury, encephalitis, etc.

Shock index is associated with mortality in canine vehicular trauma patients.

To calculate and compare shock index (SI) in healthy dogs and vehicular trauma dogs (VT), determine the prognostic value of SI in VT dogs, and to assess the correlation between SI and the animal trauma triage score, modified Glasgow Coma Scale score, and lactate in VT dogs. Retrospective study from April 2016 to February 2018. Twenty-four-hour tertiary referral level II trauma center. One hundred twenty-one dogs presented to the emergency service for VT and 60 healthy control dogs. None. Heart rate and systolic blood pressure were measured on each patient and used to calculate SI. SI was significantly higher in VT dogs compared to healthy control dogs (median SI, 1.0vs 0.75; P< 0.0001). SI was significantly higher in those that died versus those that survived to discharge (median, 1.27vs 0.96; P= 0.017). SI positively correlated with animal trauma triage score (95% confidence interval, 0.039-0.49; P= 0.019; r= 0.26) but did not with plasma lactate level at presentation (P= 0.068; r= 0.22) or modified Glasgow Coma Scale (P= 0.85; r=-0.021, 95% confidence interval, -0.24 to 0.20). SI is easy to calculate during triage of a trauma patient. Given its significant relationship with mortality, higher SIs should prompt the clinician to pursue additional monitoring, diagnostics, and intervention.

The prognostic value of the Koret CT score in dogs following traumatic brain injury

Traumatic brain injury (TBI) is a common condition in veterinary medicine with relatively high mortality rate. Recently, a study that correlated abnormal computed tomography (CT) findings with outcome in dogs with head trauma established a prognostic scoring system termed Koret CT score (KCTS). The purpose of this study was to evaluate the accuracy of the KCTS in making short- and long-term prognosis in dogs presented within 72 h of TBI.Thirty-five dogs that were admitted to a hospital during 2010–2019 with TBI and were CT-scanned within 72 h of injury were included in the study. Retrospectively collected data included signalment, modified Glasgow Coma Scale score (MGCS), CT findings, and outcome, i.e. short-term (defined as 10 days) and long-term (6 months) survival. CT images were reviewed and the KCTS was calculated for all dogs. Association between KCTS and outcome was examined. A significant negative association was found between KCTS and both short- and long-term survival. The area under receiver operating characteristic curve for KCTS for short- and long-term survival was 0.9 and 0.87, respectively. Furthermore, the probability of survival in the short term was predicated by the KCTS in an almost linear fashion and a score of 3 points or less on the KCTS was associated with survival with 85% sensitivity and 100% specificity. These results validate the prognostic value of the KCTS in dogs with TBI and provide a complementary tool for serial clinical and neurological evaluation.

Development and Evaluation of a Caregiver Reported Quality of Life Assessment Instrument in Dogs With Intracranial Disease

In veterinary medicine, quality of life (QOL) assessment instruments, which are important components of the holistic evaluation of treatment success, have largely not included organ-specific concerns that may be broadly relevant to caregivers of dogs with intracranial disease. The objective of this study was to identify core questionnaire items and domains that contribute to health-related QOL (HRQOL) in dogs with intracranial disease. A questionnaire was developed that contained 39 QOL-related items encompassing physical, social/companionship, and brain-specific domains associated with the treatment of dogs with intracranial disease, and administered to caregivers of 56 dogs diagnosed with genetic, inflammatory, neoplastic, traumatic, and vascular brain diseases, 52 healthy dogs, and 20 dogs with non-neurological illnesses. Clinician derived functional measures of each dog's health status including chronic pain, Karnofsky performance, and modified Glasgow coma scale scores were also recorded. Principal component analysis refined the final questionnaire, termed the CanBrainQOL-24, to 24-items within the three domains with a minimum Cronbach's alpha of 0.7, indicative of good internal consistency. The CanBrainQOL-24 discriminated between healthy and diseased dogs. Physical and brain-specific domains were significantly different between dogs with intracranial and non-neurological diseases. Significant correlations were observed between owner reported visual analog scores and CanBrainQOL-24 scores, as well between clinician derived functional status measures and owner reported QOL. The CanBrainQOL-24 contains core questions relevant to caregiver assessment of HRQOL in dogs with a variety of intracranial diseases, and provides information that is complementary to clinician derived functional outcome measures.

Use of the modified Glasgow Coma Scale score to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with AECOPD and respiratory failure.

Sequential invasive-noninvasive ventilation (NIV) improves the outcomes of patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, there is no clear consensus on the optimal timing of the switch to sequential invasive-NIV in these patients. In the present study, a potential role for the modified Glasgow Coma Scale (GCS) score to guide sequential weaning was investigated. Patients with AECOPD and respiratory failure were prospectively recruited from three study centers (Wenling Hospital Affiliated to Wenzhou Medical University, the First Affiliated Hospital of Wenzhou Medical University and Changsha Central Hospital) between January 1st 2016 and December 31st 2018. Patients were randomly assigned to group A and B, with the switching point for sequential weaning strategy in the two groups being a modified GCS score ≥13 and 10 points, respectively. Each group included 240 patients. Baseline demographic characteristics were comparable in the two groups. The duration of invasive mechanical ventilation (IMV) in group A was significantly shorter than that in group B. However, there were no significant between-group differences with respect to the incidence of re-intubation, ventilator-associated pneumonia, in-hospital mortality or the length of hospital stay. Use of a modified GCS score ≥13 as the switching point for sequential invasive-NIV may help decrease the duration of IMV in patients with AECOPD and respiratory failure.

Modified Glasgow Coma Scale Using Serum Factors as a Prognostic Model in Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of death and disability. This study evaluated a possible relationship between serum factors at admission and the outcome of TBI. We propose a statistically validated scale for patients with TBI that combines serum factors and the Glasgow Coma Scale (GCS). Between May 2011 and July 2016, 219 patients underwent decompressive craniectomy for TBI. We assessed laboratory data on admission, and correlations with GSC and Glasgow Outcome Scale were investigated. The modified GCS was developed from a multivariable logistic regression model, which was validated with the backward stepwise method. Of 219 patients with TBI enrolled in our study, 175 were men (79.9%) and 44 were women (20.1%) with a mean age of 49.1 ± 11.5 years. Initial serum values of hemoglobin, platelets, prothrombin time, and lactate dehydrogenase were associated with in-hospital mortality. The factor score was derived by adding the following points: hemoglobin (≥13.0 g/dL= 0, <13.0 g/dL= 1), platelets (≥150× 103/mm3= 0, <150× 103/mm3= 1), prothrombin time (<13.2 seconds= 0, ≥13.2 seconds= 1), and lactate dehydrogenase (<271 U/L= 0, ≥271 U/L= 1). The modified GCS score (GCS score [range, 6-15]- FS [range, 0-4]) was calculated. The modified GCS score using serum factors extended the information provided about patient outcomes to be comparable to more complex methods. The modified GCS score may be useful to predict in-hospital mortality in patients with TBI.

Evaluating traumatic brain injury using conventional magnetic resonance imaging and susceptibility-weighted imaging in dogs

Susceptibility-weighted imaging (SWI) is a magnetic resonance imaging (MRI) sequence used for evaluating traumatic brain injury (TBI). Although SWI is being increasingly used in veterinary medicine, there are no systematic studies regarding its use. We aimed to evaluate TBI lesions by using conventional MRI and SWI in 11 dogs and determine the correlation between clinical status and conventional MRI or SWI findings. The modified Glasgow coma scale (MGCS) at presentation and a previously used MRI grading system (MRGr; grades 1–6) were used to evaluate the brain lesions, and correlations between MGCS score and each MRGr were assessed. Conventional MRI revealed 23 lesions in 11 dogs with variable MGCS scores (range: 11–17). SWI showed comparable findings for all of the lesions except for subdural hemorrhage, and it revealed additional lesions in four dogs. The median MRGr was 2 on both conventional MRI and SWI. The MRGr of the conventional MRI assessments and the MGCS scores showed a significant negative correlation (r = −0.685). In conclusion, SWI had better TBI lesion-detection ability, but conventional MRI had a better correlation with early clinical status and subdural hemorrhage. Thus, a combination of conventional MRI and SWI examinations can improve TBI diagnosis in dogs.

Computed tomographic findings in dogs with head trauma and development of a novel prognostic computed tomography-based scoring system.

OBJECTIVE To characterize CT findings and outcomes in dogs with head trauma and design a prognostic scale. ANIMALS 27 dogs admitted to the Koret School Veterinary Teaching Hospital within 72 hours after traumatic head injury that underwent CT imaging of the head. PROCEDURES Data were extracted from medical records regarding dog signalment, history, physical and neurologic examination findings, and modified Glasgow coma scale scores. All CT images were retrospectively evaluated by a radiologist unaware of dog status. Short-term (10 days after trauma) and long-term (≥ 6 months after trauma) outcomes were determined, and CT findings and other variables were analyzed for associations with outcome. A prognostic CT-based scale was developed on the basis of the results. RESULTS Cranial vault fractures, parenchymal abnormalities, or both were identified via CT in 24 of 27 (89%) dogs. Three (11%) dogs had only facial bone fractures. Intracranial hemorrhage was identified in 16 (59%) dogs, cranial vault fractures in 15 (56%), midline shift in 14 (52%), lateral ventricle asymmetry in 12 (44%), and hydrocephalus in 7 (26%). Hemorrhage and ventricular asymmetry were significantly and negatively associated with short- and long-term survival, respectively. The developed 7-point prognostic scale included points for hemorrhage, midline shift or lateral ventricle asymmetry, cranial vault fracture, and depressed fracture (1 point each) and infratentorial lesion (3 points). CONCLUSIONS AND CLINICAL RELEVANCE The findings reported here may assist in determining prognoses for other dogs with head trauma. The developed scale may be useful for outcome assessment of dogs with head trauma; however, it must be validated before clinical application.

Modified Glasgow Coma Scale Score as an Early Indicator of Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

Introduction Cerebral vasospasm (CV) is a delayed narrowing of cerebral arteries, occurring 4 to 14 days after subarachnoid hemorrhage (SAH). CV is a possible cause of delayed deterioration of patients after aneurysmal SAH (aSAH). Timely diagnostics and therapy of CV could reduce the morbidity and mortality after ruptured intracranial aneurysm (IA). Important diagnostic tool for the early detection of CV in conscious patients is neurological examination. The modified Glasgow Coma Scale score (mGCS) is derived from the Glasgow Coma Scale score (GCS) assessment of eye opening, verbal, and motor response. The mGCS score is calculated as the sum of the eye-opening response, the verbal response, and the worst motor response.

Retrospective evaluation of prognostic indicators in dogs with head trauma: 72 cases (January-March 2011).

To investigate the prognostic value of clinical and laboratory variables and scoring systems in dogs with head trauma. Retrospective study (January-March, 2011). University teaching hospital. Seventy-two client-owned dogs with a history of head trauma occurring ≤5 days prior to hospital admission. Dogs were excluded if they had an unconfirmed history of trauma, preexisting neurologic disease, or insufficient data available in the medical record. None. Data from hospital admission were collected, including vital signs; blood pressure; pulse oximetry; venous blood gases and electrolyte concentrations; plasma lactate and blood glucose concentrations; PCV; total plasma protein concentration; activated clotting time; WBC count; and serum albumin, creatinine, total bilirubin, and BUN concentrations. Modified Glasgow Coma Scale (MGCS), mentation, and animal trauma triage (ATT) scores were also calculated. Treatment with mannitol, hypertonic saline (HS), corticosteroids, benzodiazepines, or phenobarbital, and requirement for endotracheal intubation were also recorded. Outcome was classified as survival or nonsurvival to hospital discharge. Decreased pulse oximetry, pH, bicarbonate concentration, or base excess, and increased potassium concentration, lactate concentration, BUN concentration, ATT score, or mentation score were risk factors for nonsurvival. Decreased MGCS score was the strongest predictor of nonsurvival; a score ≤ 11 was 84% sensitive and 73% specific for predicting nonsurvival. Dogs were more likely to die before discharge if they required HS or endotracheal intubation. Dogs that did not survive following head trauma were more likely to have poor perfusion, severe concurrent injuries reflected by increased ATT scores, severe traumatic brain injury as evidenced by decreased MGCS or increased mentation scores, or requirement for HS administration or endotracheal intubation.

Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality.