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• W2503433340 abstract "Study objectiveTrauma victims are frequently triaged to a trauma center according to the patient’s calculated Glasgow Coma Scale (GCS) score despite its known inconsistencies. The substitution of a simpler binary assessment of GCS-motor (GCS-m) score less than 6 (ie, “patient does not follow commands”) would simplify field triage. We compare total GCS score to this binary assessment for predicting trauma outcomes.MethodsThis retrospective analysis of a statewide trauma registry includes records from 393,877 patients from 1999 to 2013. Patients with initial GCS score less than or equal to 13 were compared with those with GCS-m score less than 6 for outcomes of Injury Severity Score (ISS) greater than 15, ISS greater than 24, death, ICU admission, need for surgery, or need for craniotomy. We judged a priori that differences less than 5% lack clinical importance.ResultsThe relative differences between GCS and GCS-m scores less than 6 were less than 5% and thus clinically unimportant for all outcomes tested, even when statistically significant. For the 6 outcomes, the differences in areas under receiver operating characteristic curves ranged from 0.014 to 0.048. Total GCS score less than or equal to 13 was slightly more sensitive (difference 3.3%; 95% confidence interval 3.2% to 3.4%) and slightly less specific (difference –1.5%; 95% confidence interval –1.6% to –1.5%) than GCS-m score less than 6 for predicting ISS greater than 15, with similar overall accuracy (74.1% versus 74.2%).ConclusionReplacement of the total GCS score with a simple binary decision point of GCS-m score less than 6, or a patient who “does not follow commands,” predicts serious injury, as well as the total GCS score, and would simplify out-of-hospital trauma triage. Trauma victims are frequently triaged to a trauma center according to the patient’s calculated Glasgow Coma Scale (GCS) score despite its known inconsistencies. The substitution of a simpler binary assessment of GCS-motor (GCS-m) score less than 6 (ie, “patient does not follow commands”) would simplify field triage. We compare total GCS score to this binary assessment for predicting trauma outcomes. This retrospective analysis of a statewide trauma registry includes records from 393,877 patients from 1999 to 2013. Patients with initial GCS score less than or equal to 13 were compared with those with GCS-m score less than 6 for outcomes of Injury Severity Score (ISS) greater than 15, ISS greater than 24, death, ICU admission, need for surgery, or need for craniotomy. We judged a priori that differences less than 5% lack clinical importance. The relative differences between GCS and GCS-m scores less than 6 were less than 5% and thus clinically unimportant for all outcomes tested, even when statistically significant. For the 6 outcomes, the differences in areas under receiver operating characteristic curves ranged from 0.014 to 0.048. Total GCS score less than or equal to 13 was slightly more sensitive (difference 3.3%; 95% confidence interval 3.2% to 3.4%) and slightly less specific (difference –1.5%; 95% confidence interval –1.6% to –1.5%) than GCS-m score less than 6 for predicting ISS greater than 15, with similar overall accuracy (74.1% versus 74.2%). Replacement of the total GCS score with a simple binary decision point of GCS-m score less than 6, or a patient who “does not follow commands,” predicts serious injury, as well as the total GCS score, and would simplify out-of-hospital trauma triage." @default.
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• W2503433340 date "2016-12-01" @default.
• W2503433340 modified "2023-10-16" @default.
• W2503433340 title "Glasgow Coma Scale Motor Component (“Patient Does Not Follow Commands”) Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients" @default.
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• W2503433340 doi "https://doi.org/10.1016/j.annemergmed.2016.06.017" @default.
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