Glasgow Coma Scale as a Prognostic Tool for Predicting DNS in COP – Physician's Weekly

Jan 23, 2025
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The following is a summary of “Association of Glasgow Coma Scale with delayed neuropsychiatric sequelae in carbon monoxide poisoning: a systematic review,” published in the January 2025 issue of Emergency Medicine by Ramponi et al. 
Despite the frequent use of the Glasgow Coma Scale (GCS) in assessing acute carbon monoxide poisoning (COP), its prognostic value in predicting delayed neurological sequelae (DNS) remains uncertain.  
Researchers conducted a retrospective study to examine the association between GCS at emergency department (ED) presentation and the development of DNS in individuals with acute COP.  
They analyzed observational studies reporting on the GCS and the subsequent occurrence of DNS, searching literature from January 1980 to February 2024. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool, and a random-effects model was applied. Sensitivity analyses were performed for studies with low bias risk and varying GCS cut-offs. Evidence quality was assessed based on an adapted GRADE framework.  
The results showed that after screening 1,067 unique records, 24 studies involving 6,153 individuals were included, with 1,002 (16.2%) developing DNS. The Primary analysis of 19 studies revealed that individuals with DNS had lower GCS scores at ED arrival, with a pooled mean difference (MD) of 4.06 points [95% CI: 3.09 to 5.02]. When GCS was considered categorically with any cut-off, the pooled odds ratio (OR) for DNS development was 3.00 [95% CI: 1.80 to 5.01]. Analysis using GCS as a continuous variable confirmed its predictive value, with a pooled OR of 1.26 [95% CI: 1.19 to 1.32] for DNS per 1-point decrease in GCS.  
Investigators concluded the GCS scores could be a valuable prognostic tool for predicting the development of DNS in patients with acute COP. 
Source: jem-journal.com/article/S0736-4679(25)00017-4/abstract  

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