Glasgow Coma Scale Scoring is Often Inaccurate
Glasgow Coma Scale Scoring is Often Inaccurate
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DOI：
10.1017/s1049023x14001289
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发表时间：
2015-02-01
影响因子：
2.2
通讯作者：
Gorman, Codee
中科院分区：
文献类型：
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作者：
Bledsoe, Bryan E.;Casey, Michael J.;Gorman, Codee
简介：格拉斯哥昏迷量表（GCS）广泛应用于急诊环境;它用于指导创伤分诊和基本干预措施（如气管插管）的应用。然而，GCS评分的评分者间可靠性已被证明是低的经验丰富的用户，特别是对于运动组件。关于GCS评分的准确性和有效性之间的各种类型的紧急护理providers.Hypothesis/Problem的关注：本研究的目的是确定在现代紧急医疗服务（EMS）系统中的各种紧急护理提供者之间的GCS评分的准确性程度。这是一项前瞻性观察性研究，使用标准化视频片段，使用各种类型的急诊医疗提供者的便利样本，评估GCS评分的准确性。由两名委员会认证的神经科医生准备并评分了十个使用成人的视频短片。评分者间可靠性非常好（Cohen的kappa = 1）。受试者观看视频，然后对每个场景进行评分。科目的评分进行了比较，专家评分的两个委员会认证neurologists.Results：共217紧急供应商观看了10个视频小插曲，并提供了2,084观察GCS评分。总体GCS评分准确率为33.1%（95% CI，30.2-36.0）。在GCS的语言部分观察到最高准确度（69.2%; 95% CI，67.8-70.4）。睁眼分量是第二准确的（61.2%; 95%CI，59.5-62.9）。最不准确的部分是运动部分（59.8%; 95% CI，58.1-61.5）。少数受试者（9.2%）分配GCS评分，不存在于GCS scoring system.Conclusions：格拉斯哥昏迷量表评分不应被视为准确。应开发和验证一个更简化的评分系统。
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 kappa = 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.