How Should We Measure the “Severity” of a Brain Injury?

I recently wrote (in Wildfires and Concussions) about the relationship—or lack of relationship— between the the GCS and the GOSE.

[Reminder: The Glasgow Coma Scale (GCS) measures severity of symptoms right after the impact. The Extended Glasgow Outcome Scale (GOSE) measures how people recover from the head injury.]

They are two different scales because they’re measuring two distinctly different things. It would be like one was a scale for weight and the other was a scale (e.g., a tape measure) for height.

Not only are they measuring different things, there is no conversion table that says if you have a GCS symptoms severity score of X, you’re going to have a GOSE score of Y.

That’s because the severity of the symptoms right after a head injury don’t predict the extent of the recovery or disability the injured person will experience.

Two people can have a GCS score of 15 and experience dramatically different outcomes after a concussion due to a variety of factors including age and resilience.

This disconnect—between severity of symptoms right after an injury and the long term effects—was covered during a recent trial. The treating neurologist explained there are different ways to classify a brain injury.

Some of the examples he gave included:

• Imaging of Brain

• Symptoms Immediately After Injury

• Chronic Life Long Effects

• Ability to Function at Work and Home

Describing the injury based on imaging is helpful in terms of determining whether there’s a bleed that’s putting pressure on the brain and needs to be drained via craniotomy.

Describing the injury based on symptoms immediately after the collision is helpful information for the hospital to receive from first responders.

But these data points don’t accurately describe (or even predict) impairments that will be experienced in the future. After it’s established that there has been a brain injury, classification needs to be based on chronic impact and the extent to which it affects the person’s ability to function and quality of life. That’s where the rubber really hits the road in terms of describing a brain injury as “mild,” “moderate,” or “severe.”

#mtbi

#gcs

#gose

#concussion

#severity

#mild

#moderate

#severe