{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:32:54Z","timestamp":1787160774793,"version":"build-2736575974"},"reference-count":38,"publisher":"SAGE Publications","issue":"15-16","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Beijing Bethune Charitable Foundation","award":["2022-YJ-085-J-Z-ZZ-026"],"award-info":[{"award-number":["2022-YJ-085-J-Z-ZZ-026"]}]},{"DOI":"10.13039\/100032579","name":"Beijing Medical Award Foundation","doi-asserted-by":"crossref","award":["YXJL-2022-0351-0421"],"award-info":[{"award-number":["YXJL-2022-0351-0421"]}],"id":[{"id":"10.13039\/100032579","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University","award":["No. LCYJ-PY-38 for W.L."],"award-info":[{"award-number":["No. LCYJ-PY-38 for W.L."]}]},{"name":"Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University","award":["No. LCYJ-MS-37 for C.H.H."],"award-info":[{"award-number":["No. LCYJ-MS-37 for C.H.H."]}]},{"name":"Nanjing Drum Tower Hospital Clinical Research Fund Project","award":["2024-LCYJ-MS-08"],"award-info":[{"award-number":["2024-LCYJ-MS-08"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>\n                    Traumatic brain injury (TBI) is a leading cause of death and disability. While the Glasgow Coma Scale (GCS) guides initial assessment, single values miss evolving neurological change. In this multicenter ICU cohort integrating NSICU, MIMIC-IV, and eICU databases, we analyzed adults (\u226518 years) with TBI who had \u22653 GCS measurements within the first 120 ICU hours. Using 12-hourly measures, latent class growth modeling identified four dynamic GCS trajectories (Stable High, Rapidly Improving, Persistently Moderate, Persistently Low), and we quantified cumulative neurological burden with a mean threshold-based area-under-the-curve (TBM-AUC) summarizing time above prespecified GCS thresholds. Among 3,132 patients, mortality increased monotonically across trajectories, highest in the Persistently Low group (adjusted hazard ratio [HR] 4.95, 95% confidence interval: 3.14\u20137.81 vs. Stable High). Lower TBM-AUC was strongly associated with mortality; most pronounced at threshold 13 (HR 0.34). Age-stratified analyses showed a trajectory-by-age interaction (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.013), with Persistently Low conferring the greatest risk in both younger and older adults. Adding trajectory class to baseline predictors improved discrimination (AUC: 0.820\u20130.861,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) with consistent gains in integrated discrimination improvement, net reclassification improvement, and median risk score across Boruta-, LASSO-, and best-subset\u2013based models. Dynamic GCS trajectories and TBM-AUC provide prognostic information beyond conventional assessments and may enhance risk stratification and clinical decision-making in neurocritical care; prospective validation is warranted.\n                  <\/jats:p>","DOI":"10.1177\/08977151251406254","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T03:50:09Z","timestamp":1766721009000},"page":"1282-1294","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamic Glasgow Coma Scale Trajectories Improve Mortality Prediction in Traumatic Brain Injury: A Multicenter Intensive Care Unit Cohort Study"],"prefix":"10.1177","volume":"43","author":[{"given":"Juan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics &amp; Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man-Man","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Juan","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Medical Big Data, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long-Yang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Ya","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hua","family":"Hang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Lai","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China."},{"name":"Neurosurgical Institute, Nanjing University, Nanjing, 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