Research Reports - Meta-analysis of Glasgow Coma Scale and Simplified Motor Score in predicting traumatic brain injury outcomes

Brain Inj. 2012 Dec 19

Singh B, Murad MH, Prokop LJ, Erwin PJ, Wang Z, Mommer SK, Mascarenhas SS, Parsaik AK

Objective: To perform a systematic review and meta-analysis to compare the
Simplified Motor Score (SMS) and Glasgow Coma Scale (GCS) in predicting outcomes
in patients with traumatic brain injury (TBI). Data sources and study selection:
Ovid EMBASE, Ovid Medline, Ovid PsycInfo, evidence-based medicine reviews and
Scopus and related conference proceedings were searched through 28 February 2012
for studies comparing SMS and GCS in predicting the outcomes [emergency tracheal
intubation (ETI), clinically significant brain injuries (CSBI), neurosurgical
intervention (NSI) and mortality] in patients with TBI. A random-effects model
was used for meta-analysis. Data synthesis: Five retrospective studies were
eligible, enrolling a total of 102 132 subjects with TBI (63.4% males), with 14
670 (14.4%) ETI, 16 201 (15.9%) CSBI, 4730 (4.6%) NSI and 6725 (6.6%) mortality.
Pooled AUC of the GCS and SMS were as follows: CSBI 0.79 and 0.75 (p = 0.16), NSI
0.83 and 0.81 (p = 0.34), ETI 0.85 and 0.82 (p = 0.31) and mortality 0.90 and
0.87 (p = 0.01). The difference in AUC for mortality was 0.03. Large
heterogeneity between the studies was observed in all analyses (I(2 )> 50%).
Conclusion: In patients with TBI, SMS predicts different outcomes with similar
accuracy as GCS except mortality. However, due to heterogeneity and limited
numbers of studies, further prospective studies are required.

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