PURPOSE:Most reported cases of aspiration pneumonia occur in patients with an impaired level of consciousness, which impairs the laryngeal reflexes and the esophageal functions.
METHODS:Aims: (1)To study the correlation between the Glasgow coma scale(GCS) scores with the risk of aspiration and final mortality of patients with tuberculous meningitis(TBM) (2)To study the correlation between the GCS scores and esophageal sphincteric functions.Methodology: 30 patients of TBM were taken up for the study. GCS scoring was done at presentation, on day 4,7 and 11. Esophageal manometry for assessing resting upper esophageal sphincter(UES) and lower esophageal sphincter(LES) tone was performed. End points included aspiration pneumonia and mortality.
RESULTS:The GCS scores at presentation ranged from 5–15(mean 11.43±3.13) with maximum number of patients having a score of 12(33.3%). The GCS scores correlated well with the severity of the disease as per the Medical Research Council staging system. Raised Intracranial pressure(ICP)–The mean GCS scores were significantly lower(10.05±2.886) in those with raised ICP(p value –0.000) as compared to those without clinical evidence of raised ICP(14.75±0.707).Esophageal sphincteric tone–Patients with a low UES(p value–0.01) or LES tone (p value–0.021) had significantly lower mean GCS scores as compared to those with a normal tone. Also, the GCS showed a direct positive correlation with the UES(Pearson's correlation coefficient –0.451) and the LES tone(Pearson's correlation coefficient –0.293). Aspiration and mortality–Of the 8 patients who died in our study, 5(62.5%) had a GCS score of 8 or below and, of these 5, 4(80%) died due to aspiration. This is indicative of the high risk of esophageal sphincteric dysfunction and the risk of aspiration and mortality in patients with a GCS of below 8.
CONCLUSION:GCS scoring is a simple and objective scoring system, which may be indicative of the esophageal sphincteric functions in correlation with the severity of brain injury and the final outcome of patients with TBM.
CLINICAL IMPLICATIONS:Esophageal Sphincteric functions and correlating risk of Aspiration Pneumonia can be predicted using the simple GCS Scoring.
DISCLOSURE:Pankaj Mehta, No Financial Disclosure Information; No Product/Research Disclosure Information