RESCUEicp and the Eye of the Beholder

This reported finding might not be as straightforward to interpret as initially presented. While there are a number of scales available to assess outcome in patients after TBI3 the extended Glasgow Outcome Scale (GOSe) is the most commonly utilised. The conventional assessment of outcome after TBI has defined as “favourable” if there is full independence at 6 months (GOSe grade 5-8) and unfavourable ((GOSe grade 1-4) if there is death or severe disability. The dichotomized reporting of patients as having “favourable” or “unfavourable” outcomes depends upon the “dichotomization point” chosen.  The RESCUEicp investigators chose a non-conventional dichotomization point and rated GOSe grade 1-3 as “unfavourable” and 4-8 as “favourable”. Significant caution is needed when established scales are modified or when new points of dichotomization are used to convey long understood meanings. Under this new interpretation, favourable outcomes would not now indicate fully independent but only the ability to be left alone at home for at least 8 hours per day with an ongoing need for assistance outside the home. Indeed, there may be merit in looking at a new dichotomization point in an old scale. However, this change of meaning has an enormous impact on individuals and families and the socio-economic impact of what a favourable outcome is and is only apparent after a more considered read! Furthermore, if we shift the dichotomization point back to the...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Intensive Care Neurosurgery Alistair Nichol Decompressive craniectomy DECRA NEJM new england journal of medicine RESCUEicp TBI traumatic brain injury Source Type: blogs