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Glasgow Coma Scale Scoring is Often Inaccurate

Published online by Cambridge University Press:  09 December 2014

Bryan E. Bledsoe ,
Michael J. Casey ,
Jay Feldman ,
Larry Johnson ,
Scott Diel ,
Wes Forred  and
Codee Gorman
Bryan E. Bledsoe*
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA MedicWest Ambulance/American Medical Response, Las Vegas, NevadaUSA
Michael J. Casey
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA
Jay Feldman
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA
Larry Johnson
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA MedicWest Ambulance/American Medical Response, Las Vegas, NevadaUSA
Scott Diel
Affiliation:
MedicWest Ambulance/American Medical Response, Las Vegas, NevadaUSA
Wes Forred
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA
Codee Gorman
Affiliation:
Department of Emergency Medicine and Department of Trauma Surgery, University of Nevada School of Medicine, Las Vegas, NevadaUSA
*
Correspondence: Bryan E. Bledsoe, DO Department of Emergency Medicine University of Nevada School of Medicine 901 Ranch Lane, Suite 135 Las Vegas, Nevada 89106 USA E-mail [email protected]
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Abstract

Introduction

The Glasgow Coma Scale (GCS) is widely applied in the emergency setting; it is used to guide trauma triage and for the application of essential interventions such as endotracheal intubation. However, inter-rater reliability of GCS scoring has been shown to be low for inexperienced users, especially for the motor component. Concerns regarding the accuracy and validity of GCS scoring between various types of emergency care providers have been expressed.

Hypothesis/Problem

The objective of this study was to determine the degree of accuracy of GCS scoring between various emergency care providers within a modern Emergency Medical Services (EMS) system.

Methods

This was a prospective observational study of the accuracy of GCS scoring using a convenience sample of various types of emergency medical providers using standardized video vignettes. Ten video vignettes using adults were prepared and scored by two board-certified neurologists. Inter-rater reliability was excellent (Cohen's κ = 1). Subjects viewed the video and then scored each scenario. The scoring of subjects was compared to expert scoring of the two board-certified neurologists.

Results

A total of 217 emergency providers watched 10 video vignettes and provided 2,084 observations of GCS scoring. Overall total GCS scoring accuracy was 33.1% (95% CI, 30.2-36.0). The highest accuracy was observed on the verbal component of the GCS (69.2%; 95% CI, 67.8-70.4). The eye-opening component was the second most accurate (61.2%; 95% CI, 59.5-62.9). The least accurate component was the motor component (59.8%; 95% CI, 58.1-61.5). A small number of subjects (9.2%) assigned GCS scores that do not exist in the GCS scoring system.

Conclusions

Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.

BledsoeBE, CaseyMJ, FeldmanJ, JohnsonL, DielS, ForredW, GormanC. Glasgow Coma Scale Scoring is Often Inaccurate. Prehosp Disaster Med. 2015;30(1):1-8.

Keywords

emergency careEmergency Medical ServicesGlasgow Coma Scoretrauma care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 1 , February 2015 , pp. 46 - 53
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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Footnotes

Conflicts of interest: none

References

1. Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-84.Google Scholar
2. Jennett, B, Teasdale, G. Aspects of coma after severe head injury. Lancet. 1977;1(8017):878-881.Google Scholar
3. Jennett, B, Teasdale, G, Braakman, R, Minderhoud, J, Knill-Jones, R. Predicting outcome in individual patients after severe head injury. Lancet. 1976;1(7968):1031-1034.CrossRefGoogle ScholarPubMed
4. Perel, P, Arango, M, Clayton, T, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336(7641):425-429.Google Scholar
5. Murray, GD, Butcher, I, McHugh, GS, et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):329-337.Google Scholar
6. Stevens, RD, Sutter, R. Prognosis in severe brain injury. Crit Care Med. 2013;41(14):1104-1123.Google Scholar
7. Gill, MR, Reiley, DG, Green, SM. Inter-rater reliability of Glasgow Coma Scale Scores in the emergency department. Ann Emerg Med. 2004;43(2):215-223.Google Scholar
8. Holdgate, A, Ching, N, Angonese, L. Variability in agreement between physicians and nurses when measuring the Glasgow Coma Scale in the emergency department limits its clinical usefulness. Emerg Med Australas. 2006;18(4):379-384.Google Scholar
9. Bazarian, JJ, Eirich, MA, Salhanick, SD. The relationship between prehospital and emergency department Glasgow Coma Scale score. Brain Inj. 2003;17(7):553-560.CrossRefGoogle Scholar
10. Tujin, S, Janssens, F, Robben, R, Van Den Bergh, H. Reducing inter-rater variability and improving health care: a meta-analytical review. J Eval Clin Pract. 2012;18(4):887-895.Google Scholar
11. Juarez, VJ, Lyons, M. Inter-rater reliability of the Glasgow Coma Scale. J Neurosci Nurs. 1995;27(5):283-286.Google Scholar
12. Prasad, K. The Glasgow Coma Scale: a critical appraisal of its clinometric properties. J Clin Epidemiol. 1996;49(7):755-763.Google Scholar
13. Segatore, M, Way, C. The Glasgow Coma Scale: time for a change. Heart Lung. 1992;21(6):548-557.Google Scholar
14. Menegazzi, JJ, Davis, EA, Sucov, AN, Paris, PM. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma. 1993;34(1):46-48.Google Scholar
15. Heron, R, Davie, A, Gillies, R, Courtney, M. Inter-rater reliability of the Glasgow Coma Scale scoring among nurses in sub-specialties of critical care. Aust Crit Care. 2001;14(3):100-105.Google Scholar
16. Kerby, JD, MacLennan, PA, Burton, JN, McGwin, G, Rue, LW. Agreement between prehospital and emergency department Glasgow Coma Scores. J Trauma. 2007;63(5):1026-1031.Google Scholar
17. Lane, PL, Báez, AA, Brabson, T, Burmeister, DD, Kelly, JJ. Effectiveness of a Glasgow Coma Scale instructional video for EMS providers. Prehosp Disaster Med. 2002;17(3):142-146.Google Scholar
18. Gill, M, Steele, R, Windemuth, R, Green, SM. A comparison of five simplified scales to the out-of-hospital Glasgow Coma Scale for the prediction of traumatic brain injury outcomes. Acad Emerg Med. 2006;13(9):968-973.Google Scholar
19. Gill, M, Martens, K, Lynch, EL, Salih, A, Green, SM. Inter-rater reliability of 3 simplified neurologic scales applied to adults presenting to the emergency department with altered levels of consciousness. Ann Emerg Med. 2007;49(4):403-407;407.e1.Google Scholar
20. Brain Trauma Foundation. Guidelines for the pehospital management of severe traumatic brain injury. Prehosp Emerg Care. 2007;12(Supplement1):S14-S19.Google Scholar
21. Braakman, R, Avezaat, CJJ, Maas, AIR, et al. Interobserver agreement in the assessment of the motor response of the Glasgow ‘Coma’ Scale. Clin Neural Neurosurg. 1978;80(2):100.Google Scholar