New score predicts complications after mild traumatic brain injury

A study led by researchers at the Institute for Research in Biomedicine of Lleida (IRBLleida), the University of Lleida (UdL), the Universitat Oberta de Catalunya (UOC) and Arnau de Vilanova University Hospital (HUAV) has developed and internally validated a clinical prediction model called the Goliat score, which can be used by emergency services to estimate the risk of acute complications in patients suffering from minor and moderate traumatic brain injuries (TBIs). The study was recently published in BMC Emergency Medicine.

Non-severe head trauma accounts for a large proportion of emergency room visits, but most patients do not develop important clinical complications within 48 hours of their injury. "Early detection of the patients who are most at risk continues to be a fundamental clinical challenge for optimizing discharge decisions, clinical monitoring and the use of computed tomography," said the head of the ERLab Emergency Medicine research group at IRBLleida, Oriol Yuguero, who is also a researcher at the UOC and a member of the e-RLab Ethics, Equity and Digital Tools for Health Improvement research group, affiliated to the eHealth Centre.

The Goliat score was constructed based on a consecutive cohort study of adults with mild or moderate TBI (a Glasgow Coma Scale score of 13-15), who were treated in a hospital emergency department in Lleida between June 2019 and December 2020. The model contains variables that can be obtained in less than six hours, including age, history of hypertension, platelet count, systolic blood pressure, anticoagulant treatment, serum levels of the S100B protein, and high-risk clinical indicators such as fluctuating GCS and pupil alterations, and predicts the likelihood of neurological or cardiorespiratory complications and mortality in the first 48 hours.

The results show that the Goliat score can discriminate between patients at high and low risk of developing complications.

The model performed similarly in age and sex subgroups, although it requires prospective external validation before it can be routinely applied in clinical practice." 

Oriol Yuguero, researcher, UOC

According to the researchers, this tool could limit unnecessary exposure to radiation, reduce the use of cranial computed tomography (CT) and enable safer and risk-based discharge decisions, especially among elderly patients, when the presence of multiple comorbidities can make clinical evolution difficult.

This study is a significant step towards achieving simple yet robust clinical predictive models that contain immediately available demographic, laboratory and clinical data for improving the care of patients with minor or moderate traumatic brain injury in emergency services. The project was funded by the Mutua Madrileña Foundation.

This project is part of the UOC's research mission on Planetary Health and Well-being and supports UN Sustainable Development Goal (SDG) 3: Ensure healthy lives and promote well-being for all at all ages.