Evaluating different types of GOSE scores among patients treated in trauma centers in the US

A new study in the peer-reviewed Journal of Neurotrauma aims to determine the extent to which Glasgow Outcome Scale Extended (GOSE) scores that take into account the combined effect of the brain and extracranial injuries (GOSE-All scores) differ from scores excluding effects attributed to extracranial injuries (GOSE-TBI scores) among patients who were treated at Level 1 trauma centers in the U.S. Click here to read the article now.

GOSE is the most widely used outcome measure for hospital-based studies of traumatic brain injury (TBI). Nancy Temkin, PhD, from the University of Washington, and coauthors, examined the differences in reported disability between GOSE-All and GOSE-TBI at 2 weeks and 3,6, and 12 months after injury from patients enrolled in the TRACK-TBI study.

The investigators reported that “Discrepancies in disability captured by GOSE-All and GOSE-TBI decrease with greater TBI severity, no serious extracranial injuries and longer time post-injury. It is important for researchers, given the aims of their studies, to decide in advance whether GOSE classification should be based on effects of all injuries sustained or excluding the effects of extracranial injuries so as to emphasize the effects of the brain injury, as well as how disability due to emotional consequences of injury and other circumstances will be scored.”

“Neither approach to scoring the GOSE is right or wrong,” concluded the investigators. “Which approach is preferable depends on the purpose of the study. If one is evaluating a relationship of brain-injury specific biomarkers to outcome or looking for an outcome for a clinical trial of a treatment that affects only the brain, GOSE-TBI may be more sensitive. If, however, one is interested in describing the overall impact of an injury on a person’s functioning or one wants to balance the positive effects on the brain of a potential treatment with adverse side effects on the cardiac or respiratory system, GOSE-All might provide that balance.”

“"This is an important paper because it helps address an issue that may have been limiting the quality of the randomized controlled trials in the field of traumatic brain injury. If the GOS-E is going to be the primary outcome measure for a trial, it makes sense to define it as precisely as possible. I could easily envision future therapeutic trials involving moderate to severe TBI using the GOSE-TBI (excluding extracranial injuries), once the multi-center inter-rater reliability of this approach is firmly established." says David L. Brody, MD, PhD, Editor-in-Chief of Journal of Neurotrauma.

About the Journal
Journal of Neurotrauma is an authoritative peer-reviewed journal published 24 times per year in print and online that focuses on the latest advances in the clinical and laboratory investigation of traumatic brain and spinal cord injury. Papers and reviews focus on clinical trials, fluid biomarkers, imaging, clinical studies, pathophysiological mechanisms, translational therapeutics, and biomechanics. Journal of Neurotrauma is the official journal of the National Neurotrauma Society and the International Neurotrauma Society. Complete tables of content and a sample issue may be viewed on the Journal of Neurotrauma website.

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