{"doi":"10.1089/neu.2024.0458","title":"Validation of the GCS−Pupil Scale in Traumatic Brain Injury: Incremental Prognostic Value of Pupillary Reactivity with GCS in the Prospective Observational Cohorts CENTER-TBI and TRACK-TBI","abstract":"To compare the incremental prognostic value of pupillary reactivity captured as part of the Glasgow Coma Scale–Pupils (GCS–P) score or added as separate variable to the GCS+P, in traumatic brain injury (TBI). We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n = 3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n = 1439) cohorts. Logistic regression was utilized to quantify the prognostic performances of GCS–P (GCS minus number of unreactive pupils) and GCS+P versus GCS alone according to Nagelkerke’s R 2. End-points were mortality and unfavorable outcome (Glasgow Outcome Scale–Extended score 1–4) at 6 month post-injury. We estimated 95% confidence intervals (CIs) with bootstrap resampling to summarize the improvement in prognostic capability. In a meta-analysis of CENTER-TBI and TRACK-TBI, GCS as a linear score had a R 2 of 25% (95% CI 19–31%) for mortality and 33% (4–41%) for unfavorable outcome. Pupillary reactivity as a separate variable improved the R 2 by an absolute value of 6% (4.0–7.7%) and 2% (1.2–3.0%) for mortality and unfavorable outcome, respectively, while comparatively half of this improvement was captured by the GCS–P score (3% [2.1–3.3%], 1% [1–1.7%], respectively). GCS–P showed a stronger association with 6-month outcome after TBI than GCS alone and provides a single integrated score. However, this comes at a loss of clinical and prognostic information compared with GCS+P. For prognostic models, inclusion of GCS and pupillary reactivity as separate factors may be preferable to using a GCS–P summary score.","journal":"Journal of Neurotrauma","year":2024,"id":437529,"datarank":0.49760889767043665,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.12487290020223651,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.12487290020223651,"corpus_percentile":61.52239498723602,"corpus_rank":4975,"citation_count":11,"citer_count":8,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.5368,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1247038,"name":"Florian D. van Leeuwen","orcid":"0009-0009-7092-2848","position":1,"is_corresponding":false},{"id":30635,"name":"Geoffrey T. Manley","orcid":null,"position":2,"is_corresponding":false},{"id":84743,"name":"Paul M. Brennan","orcid":"0000-0002-7347-830X","position":4,"is_corresponding":false},{"id":410168,"name":"Xiaoying Sun","orcid":null,"position":5,"is_corresponding":false},{"id":264448,"name":"Sonia Jain","orcid":"0000-0001-8408-1247","position":6,"is_corresponding":false},{"id":838711,"name":"Thomas A. van Essen","orcid":"0000-0003-4657-5283","position":7,"is_corresponding":false},{"id":98070,"name":"Wilco C. Peul","orcid":"0000-0001-7274-1447","position":8,"is_corresponding":false},{"id":618718,"name":"Andrew I.R. Maas","orcid":"0000-0003-1612-1264","position":9,"is_corresponding":false},{"id":317356,"name":"David Menon","orcid":"0000-0002-3228-9692","position":10,"is_corresponding":false},{"id":29499,"name":"Ewout W. Steyerberg","orcid":"0000-0002-7787-0122","position":11,"is_corresponding":false},{"id":330942,"name":"John K. Yue","orcid":"0000-0001-9694-7722","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-19T02:00:34.490087Z","pmid":"39686742","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}