TY  - JOUR
PY  - 2019//
TI  - Glasgow Outcome Scale measures and impact on analysis and results of a randomized clinical trial of severe TBI
JO  - Journal of neurotrauma
A1  - Yamal, José-Miguel
A1  - Hannay, H. Julia
A1  - Gopinath, Shankar P.
A1  - Aisiku, Imoigele
A1  - Benoit, Julia S.
A1  - Robertson, Claudia S.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - The original unstructured Glasgow Outcome Scale (uGOS) and the newer structured interviews GOS and GOSE have been used widely as outcomes in severe traumatic brain injury (TBI) trials. We compared outcome categories (ranging from dead to good recovery) for each measure in a randomized trial of transfusion threshold and the implications of measure choice and analysis methods for the results of the trial. We planned to explore patient symptomology possibly driving any discrepancies between the patient's uGOS and GOS scores. Category correspondence between uGOS and GOS scores occurred in 160 (88.4%) of the 181 analyzed cases. The GOSE and GOS instruments incorporated more behavioral/cognitive/social and other components, leading to a worse outcome in some cases than for the uGOS. Choice of outcome measure and analysis led to incongruous conclusions. Dichotomizing uGOS into favorable outcome (good recovery and moderate disability categories) versus unfavorable (severe disability, vegetative state, and dead categories), we observed a significant effect of transfusion threshold (odds ratio [OR]=0.51, p=0.03; adjusted OR=0.40, p=0.02). For the same dichotomization of GOS and GOSE, the effect was not statistically significant but the ORs were similar (ORs between 0.57 and 0.68, p>0.15 for all). An effect was not detected using ordinal logistic regression or sliding dichotomy method for all three measures. Differences in categorizations of subjects between moderate and severe disability among the scales impacted conclusions of the trial. In future studies, particular attention should be given to implementing GOS measures and describing the methodology for how outcomes were ascertained.<p />  <p>Language: en</p>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2018.5939
ID  - ref1
ER  -