Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

Research output: Contribution to journalArticle

Abstract

Background: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

Original languageEnglish
Article number65
JournalBMC Emergency Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - Nov 6 2019

Fingerprint

Coma
Hospital Mortality
Japan
Wounds and Injuries
Glasgow Coma Scale
ROC Curve
Logistic Models
Regression Analysis
Confidence Intervals
Consciousness
Registries
Cohort Studies
Retrospective Studies
Odds Ratio
Databases
Mortality

Keywords

  • Glasgow coma scale
  • Japan Coma Scale
  • Mortality
  • Trauma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{217b1fae5c264eb2b233e41e25121071,
title = "Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients",
abstract = "Background: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1{\%} (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95{\%} CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95{\%} confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.",
keywords = "Glasgow coma scale, Japan Coma Scale, Mortality, Trauma, Traumatic brain injury",
author = "Tetsuya Yumoto and Hiromichi Naito and Takashi Yorifuji and Toshiyuki Aokage and Noritomo Fujisaki and Atsunori Nakao",
year = "2019",
month = "11",
day = "6",
doi = "10.1186/s12873-019-0282-x",
language = "English",
volume = "19",
journal = "BMC Emergency Medicine",
issn = "1471-227X",
publisher = "BioMed Central",
number = "1",

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TY - JOUR

T1 - Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

AU - Yumoto, Tetsuya

AU - Naito, Hiromichi

AU - Yorifuji, Takashi

AU - Aokage, Toshiyuki

AU - Fujisaki, Noritomo

AU - Nakao, Atsunori

PY - 2019/11/6

Y1 - 2019/11/6

N2 - Background: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

AB - Background: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

KW - Glasgow coma scale

KW - Japan Coma Scale

KW - Mortality

KW - Trauma

KW - Traumatic brain injury

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