Phoenix Sepsis Neurological Score

Assessment of neurologic dysfunction based on Glasgow Coma Scale (GCS) and pupil reactivity. This score is part of the diagnostic Phoenix Sepsis criteria and Phoenix 8 Sepsis criteria.

Usage

phoenix_neurologic(
  gcs = NA_integer_,
  fixed_pupils = NA_real_,
  data = parent.frame(),
  ...
)

Arguments

gcs

integer vector; total Glasgow Comma Score

fixed_pupils

integer vector; 1 = bilaterally fixed pupil, 0 = otherwise

data

a list, data.frame, or environment containing the input vectors

...

pass through

Value

an integer vector with values 0, 1, or 2. As with all Phoenix organ dysfunction scores, missing input values map to scores of zero.

Details

Missing values will map to a value of 0 as was done when developing the Phoenix criteria. Note that this is done on a input by input basis. That is, if pupil reactivity is missing but GCS (total) is 9, then the neurologic dysfunction score is 1.

GCS total is the sum of a score based on eyes, motor control, and verbal responsiveness.

Eye response:

1. no eye opening,

2. eye opening to pain,

3. eye opening to sound,

4. eyes open spontaneously.

Verbal response:

1. no verbal response,

2. incomprehensible sounds,

3. inappropriate words,

4. confused,

5. orientated

Motor response:

1. no motor response,

2. abnormal extension to pain,

3. abnormal flexion to pain,

4. withdrawal from pain,

5. localized pain,

6. obeys commands

Phoenix Neurological Scoring

Bilaterally fixed pupil	2 points
Glasgow Coma Score (total) less or equal 10	1 point
Reactive pupils and GCS > 10	0 point

References

See reference details in phoenix-package or by calling citation('phoenix').

See also

• phoenix for generating the diagnostic Phoenix Sepsis score based on the four organ systems:

  • phoenix_cardiovascular,

  • phoenix_coagulation,

  • phoenix_neurologic,

  • phoenix_respiratory,

• phoenix8 for generating the diagnostic Phoenix 8 Sepsis criteria based on the four organ systems noted above and

  • phoenix_endocrine,

  • phoenix_immunologic,

  • phoenix_renal,

  • phoenix_hepatic,

vignette('phoenix') for more details and examples.

Examples

# using the example sepsis data set
phoenix_neurologic(
  gcs = gcs_total,
  fixed_pupils = as.integer(pupil == "both-fixed"),
  data = sepsis
)
#>  [1] 0 1 0 0 0 1 0 0 1 1 2 0 0 0 0 0 0 0 0 0

# build an example data set with all possible neurologic scores
DF <- expand.grid(gcs = c(3:15, NA), pupils = c(0, 1, NA))
DF$target <- 0L
DF$target[DF$gcs <= 10] <- 1L
DF$target[DF$pupils == 1] <- 2L
DF$current <- phoenix_neurologic(gcs, pupils, DF)
stopifnot(identical(DF$target, DF$current))
DF
#>    gcs pupils target current
#> 1    3      0      1       1
#> 2    4      0      1       1
#> 3    5      0      1       1
#> 4    6      0      1       1
#> 5    7      0      1       1
#> 6    8      0      1       1
#> 7    9      0      1       1
#> 8   10      0      1       1
#> 9   11      0      0       0
#> 10  12      0      0       0
#> 11  13      0      0       0
#> 12  14      0      0       0
#> 13  15      0      0       0
#> 14  NA      0      0       0
#> 15   3      1      2       2
#> 16   4      1      2       2
#> 17   5      1      2       2
#> 18   6      1      2       2
#> 19   7      1      2       2
#> 20   8      1      2       2
#> 21   9      1      2       2
#> 22  10      1      2       2
#> 23  11      1      2       2
#> 24  12      1      2       2
#> 25  13      1      2       2
#> 26  14      1      2       2
#> 27  15      1      2       2
#> 28  NA      1      2       2
#> 29   3     NA      1       1
#> 30   4     NA      1       1
#> 31   5     NA      1       1
#> 32   6     NA      1       1
#> 33   7     NA      1       1
#> 34   8     NA      1       1
#> 35   9     NA      1       1
#> 36  10     NA      1       1
#> 37  11     NA      0       0
#> 38  12     NA      0       0
#> 39  13     NA      0       0
#> 40  14     NA      0       0
#> 41  15     NA      0       0
#> 42  NA     NA      0       0