Document Type : Research articles

Authors

• Neda Gilani ^{1, 2}
• Anoshirvan Kazemnejad ¹
• Farid Zayeri ³
• Mohammad Asghari Jafarabadi ⁴
• Fatemeh Sadat Izadi Avanji ⁵

¹ Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

² Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran

³ Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴ Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

⁵ Department of Medical Surgical Nursing, Faculty of Nursing, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Background: Traumatic brain injury (TBI) is an important public health problem throughout the world.
Objectives: The aim of this study was to assess repeated glasgow coma scale (GCS) scores in predicting the severity of TBI and patients’ survival.
Patients and Methods: In this longitudinal study used a total sample of 239 patients, all of whom were hospitalized with traumatic brain injuries. Subjects were selected by simple random sampling in intensive care unit (ICU) wards of the Shahid Beheshti hospital in Kashan, Iran between September 2008 and September 2010. The patients’ level of consciousness was evaluated using GCS at admission, six hours after admission to the ICU, and at the time of discharge from the hospital. A Glasgow outcome score (GOS) is used to classify the global outcomes in TBI survivors. A joint modeling approach was utilized for data analysis using R software.
Results: The results showed that female patients had the risk of occurrence, slightly more than men, but this was not significant
(HR =1.095 P = 0.757). The mortality risk was significantly higher in older patients (HR = 1.010, P = 0.010). In addition, the results
indicated a significant increasing linear trend in GCS values over time (HR=1.78, P=0.003). Higher age was also associated with lower
GCS values over time (P < 0.001). The severity of TBI decreases with increasing GCS values (P < 0.001).
Conclusions: By jointly modeling longitudinal data with time-to-event outcomes, our findings supported the use of the GCS scores
in predicting the severity of TBI.

Keywords

• Brain Injuries
• Glasgow Coma Scale
• Survival Analysis