Letter to the Editor. Missing Glasgow Coma Scale verbal component scores

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  • All India Institute of Medical Sciences, New Delhi, India
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TO THE EDITOR: We went through the article written by Brennan et al.1 with great interest and found their report remarkably interesting and useful (Brennan PM, Murray GD, Teasdale GM. A practical method for dealing with missing Glasgow Coma Scale verbal component scores. J Neurosurg. Published online September 8, 2020. doi:10.3171/2020.6.JNS20992). As rightly concluded by the authors, the verbal scores derived by imputation will help clinicians arrive at a Glasgow Coma Scale (GCS) sum score which will help in filling in missing data while calculating prognostication scores. We commend in particular the development of the visual aid for imputation of a verbal score based on the eye and motor scores of the GCS. We look forward to using the described method while collecting data for our own research purposes.

However, a single issue that we would like to address here did catch our attention when we were going through the data tables. Table 2 in the paper by Brennan et al. shows the distribution of verbal scores based on eye and motor scores that were collected from the Trauma Audit and Research Network (TARN), Victorian State Trauma Registry (VSTR), and Corticosteroid Randomisation After Significant Head Injury (CRASH) trial databases. The verbal scores corresponding to eye and motor scores of 1 (E1M1) ranged from V1 to V5. Though V1 accounts for 94.2% of the responses (Table 3 in the paper), we could not help but wonder if it is possible for an E1M1 patient to have a verbal score of anything other than V1. Brennan et al.1 reported that 24 E1M1 patients had a full verbal score of V5 (Tables 2 and 3). Likewise, 26 M2 patients had shown full verbal scores. There seems to be an error in the data collection of the registries used by the authors.

Finally, we would like to congratulate the authors on coming up with such an innovative tool, which will surely help researchers in data collection and analysis with respect to the GCS.

Disclosures

The authors report no conflict of interest.

References

1

Brennan PM, Murray GD, Teasdale GM. A practical method for dealing with missing Glasgow Coma Scale verbal component scores. J Neurosurg. Published online September 8, 2020. doi:10.3171/2020.6.JNS20992

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  • 1 Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom;
  • 2 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom; and
  • 3 Institute of Health and Wellbeing, University of Glasgow, United Kingdom

Response

We are pleased that Dr. Gaonkar and colleagues find merit in our practical method for dealing with missing Glasgow Coma Scale (GCS) verbal component scores as reported in our article.

Gaonkar et al. raise a concern about the spread of the scores for the verbal component of the GCS for each eye and motor component combination (EM). They contend that in a patient with component scores of E1M1, the verbal component score (V) can only be V1. This is probably not the case. From the data presented in Table 2 of our article, 4.5% of people who were E1M1 had a verbal component score of 2, which from clinical experience is entirely plausible. V component scores of 3, 4, or 5 seem less plausible clinically, and indeed, the component category for each of these scores has fewer than 0.6% of patients.

The data in Table 2 were kindly made available to us by the primary investigators and we cannot say if they represented coding or transcription errors—which in addition to the V component might have been in the M or E component—or some extremely unusual clinical scenario. For this reason, the data should not be changed or discarded. It is the large number of patients included in our analysis that gives a clear picture of the most characteristic associations between EM combination and V component scores and highlights the robustness of our practical approach to imputation. We note too that the small number of questionable values in the database have no impact on the conclusions of our analysis.

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Contributor Notes

Correspondence Vishwa Bharathi Gaonkar: vibha.gaonkar92@gmail.com.

INCLUDE WHEN CITING Published online March 19, 2021; DOI: 10.3171/2021.1.JNS21172.

Disclosures The authors report no conflict of interest.

  • 1

    Brennan PM, Murray GD, Teasdale GM. A practical method for dealing with missing Glasgow Coma Scale verbal component scores. J Neurosurg. Published online September 8, 2020. doi:10.3171/2020.6.JNS20992

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    • Export Citation

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