7/2/2023 0 Comments Pupil size chart to scale![]() ![]() They make no eye, verbal or motor movements spontaneously, or in response to your spoken requests. You are asked to assess a 50 year old patient who has been ejected from the passenger seat of a car at high velocity. Separate GCS-PA charts show prognosis according to if the patient’s scan shows none, only one, or two or more of the specified abnormalities. ![]() Prognosis is poorer for combinations towards the bottom left hand corner of the chart and, conversely, better for combinations towards the top right hand corner. ![]() The data are the percentage likelihood of either mortality (death or persistent vegetative state) or independent favourable outcome (Glasgow Outcome Scale moderate disability or good recovery) at 3-6 months after injury. The combined effects of GCS-P and age are displayed on 2D charts (download) with increasing GCS-P along the ‘x’, horizontal axis, and age decreasing in 5 year bands from over 86 to 16 on the ‘y’, vertical axis. Mortality rises and the rate of favourable outcome falls as the number of abnormal findings increase. In victims aged 16 – 18 yrs the rate of mortality is 18% and of favourable recovery 68% among those aged 86 yrs or older mortality is 77% and the rate of favourable outcome 10%.ĬT Scan findings: The severity of structural brain damage shown by the CT scan is categorised by the presence or absence of three main findings: a hematoma, subarachnoid haemorrhage or absence of the basal cisterns. Further information on assessment of the GCS and GCS-P can be accessed here.Īge: Outcome worsens progressively with increasing age. The GCS-P has a range of 1–15 over which there is a continuous fall in mortality from 79% to 14% and increase in favourable outcome from 11% to 80%. Outcome 3 – 6 months after injury was classified into 2 groups: either mortality (includes 1.3% judged to be in vegetative state) or favourable, independent recovery (Moderate disability or Good recovery on Glasgow Outcome Scale)Ĭlinical features: The clinical indices of prognosis, the GCS Score and the pupil reactivity, are brought together in a combined GCS-P score.3 This is obtained by subtracting the Pupil Reactivity Score (PRS) ( 0 – 2) from the Glasgow Coma Scale (GCS) total score ( 3 -15): The Charts are derived from information about 10,702 adult head injured patients. The Charts are a user-friendly, graphical displays that bring together information about four of the most important features relating to outcome after a head injury in a way that can be easily applied clinically. This leaves decisions about patient care exposed to the influence of clinicians personal, highly variable, subjective opinions, which tend to be overly pessimistic.2 This may reflect clinicians’ unease about dealing with explicit, calculated mathematical probabilities, a lack of clarity about the influence of their various components and opaqueness about the process of deriving the prediction as well as the lack of utility from the extra work required. The stimulus to the development of the Charts was that despite several decades of interest and descriptions of more than 100 methods for making predictions of an individual patient’s outcome, these have not found a role in clinical practice. They were developed by Gordon Murray, Paul Brennan and Graham Teasdale, and published by the Journal of Neurosurgery in 2018 1 ( Link). The GCS Pupils Age prognostic charts provide a simple graphical presentation of the probabilities of outcome from traumatic brain injury based on GCS, pupil reactivity, age and CT scan findings. Download GCS-PA Charts Using Prognostic Information after a head injury ![]()
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