Prospective evaluation of the Eppendorf-Cologne Scale

OBJECTIVES: Early diagnosis of traumatic brain injury and reliable prediction of outcome are essential for determining treatment strategies and allocating resources. This study re-evaluates the Eppendorf-Cologne Scale (ECS) and its predictive accuracy for outcome compared with the Glasgow Coma Scale (GCS).

METHODS: A prospective cohort analysis of severely injured trauma patients registered in the Trauma Registry of the German Society for Trauma Surgery from 2012-2013 was carried out. Only directly admitted patients alive on admission with complete data on GCS, ECS and outcome in terms of survival to hospital discharge or death were included. The predictive accuracy in terms of the outcome of the ECS and the GCS was modelled using area under the receiver operating characteristic (AUROC) curve analysis.

RESULTS: A total of 17 616 patients fulfilled the study inclusion criteria. The ECS outmatched the predictive accuracy of the GCS for outcome (AUROC, 0.853, 95% confidence interval, 0.831-0.854; and AUROC 0.836; 95% confidence interval, 0.825-0.848, respectively; P=0.062). An ECS score of 8 was associated with a 25-fold higher mortality compared with an ECS score of 0. Patients who had an ECS score of 8 had a 1.5-fold higher mortality compared with patients allocated a GCS score of 3.

CONCLUSION: The ECS shows a higher accuracy for prediction of outcome compared with the GCS and enables further differentiation within the critical GCS 3 collective.