The effect of the modeling created by assigning the verbal component score to the Glasgow Coma Scale and adding pupillary reaction on the determination of morbidity/mortality in patients with traumatic brain injury

The study data were collected by the investigators through face-to-face assessment using the following scales;
Case report form: It consists of a total of 14 questions including socio-demographic, trauma and vital signs of the patients.
Modification of the Pupil LR score to obtain the Modified GCS-P (mGCS-P) score;
In the study which it was first derived from, the LR score was evaluated as 0-2 points and subtracted from the total GCS score to obtain a GCS-P total score between 1-15 points [5]. In our study, pupil LR was modified as follows to increase the weight of abnormal pupil LR scores and to evaluate patients with anisocoria in a separate category despite positive LR on both sides;
• Both pupils react to light and there is no anisocoria - 0 points,
• Anisocoria despite bilateral positive light reflex -1 points,
• If one pupil does not react to light -2 points,
• Both pupils do not respond to light -3 points,
These scores were subtracted from the GCS total score to obtain the mGCS-P total score (0-15).
In our study, the first GCS performed by neurosurgery residents who were blinded to the study and not included in the study after the admission of the patients to the hospital and the pupillary LR findings during this evaluation were used. The pupillary evaluation was performed with the same light source, approximately 20-30 cm above the eye, and each pupil was evaluated separately by opening the eyelids by the evaluator if the patient could open his/her own eyes or by the patient himself/herself if not [10, 11]. Pre-hospital data were not included in the study. In the hospital where the study was conducted, GCS and pupillary assessment are routinely evaluated hourly or every four/six hours depending on the general condition of the patient with TBI. Pupil size was assessed in mm using the French Catheter Scale [10]. A difference of ≥ 1 mm between pupil sizes was considered as anisocoria. Bilateral pupils ≥ 4 mm in diameter were defined as fixed and dilated pupils.
Glasgow outcome scale: The scale is classified into five categories ranging from death to full recovery. A score of four or five on the scale is classified as a favorable functional outcome, while a score of two or three is classified as an unfavorable functional outcome.
Abbreviated injury scale-head: It is an anatomical scoring system used to classify and describe injury severity . In this scale, there is a scoring system ranging from one to six for injuries. In the scoring system, one point indicates a minor injury, five points indicate a critical injury, and six points indicate an injury incompatible with life.
Marshall Computed Tomography (CT) classification: In this classification based on brain
CT findings, patients are divided into six categories ranging from normal CT findings to the presence of a non-surgically evacuated, high or mixed density lesion.