Association of the Glasgow Coma Scale with the Length of Hospital Stay in Patients with Thyroid Storm

Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. Thyroid storm was diagnosed based on the latest diagnostic criteria in Japan. Since 30 days is the upper limit of LOS in the Diagnosis Procedure Combination [DPC]-based reimbursement system, the study population was divided into patients with permissible LOS (<30 days) and those with undesirable LOS (≥30 days). As a supplementary analysis, we examined the correlation of the GCS score and other clinical parameters with LOS using a Spearman's rank correlation analysis. Results The GCS score was significantly higher (14.1±2.7 vs. 9.9±4.9 points; p<0.001), and the Sequential Organ Failure Assessment (SOFA) score significantly lower (1.68±2.16 vs. 7.50±7.91 points; p=0.009) in patients with permissible LOS than in those with undesirable LOS, while other clinical parameters were not significantly different between the groups. The area under the receiver operating characteristic curve of the GCS for the permissible vs. undesirable LOS was 0.866. The baseline parameters that were significantly correlated with LOS were the GCS (ρ=-0.665; p<0.001) and SOFA score (ρ=0.670; p<0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ=-0.390; p=0.040). Conclusion GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.