Interrater reliability of Glasgow Coma Scale scores in the emergency department
Interrater reliability of Glasgow Coma Scale scores in the emergency department
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DOI：
10.1016/s0196-0644(03)00814-x
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发表时间：
2004-02-01
影响因子：
6.2
通讯作者：
Green, SM
中科院分区：
文献类型：
--
作者：
Gill, MR;Reiley, DG;Green, SM
研究目的：急诊医生经常使用格拉斯哥昏迷量表 (GCS) 来帮助指导患者护理决策，但 GCS 的可靠性从未在急诊科 (ED) 患者的典型广泛样本中进行过测试。当评估意识水平改变的成年患者时，我们确定了急诊医生之间 GCS 的受试者间可靠性。 方法：在大学 I 级创伤中心的这项前瞻性观察研究中，我们纳入了 17 岁以上出现意识水平改变的 ED 患者的方便样本。两名接受过住院医师培训的急诊主治医生在 5 分钟内以盲法独立评估和记录 GCS 评分及其组成部分（眼睛、语言和运动）。通过使用标准序数计算来分析数据的参与者间可靠性。我们还为每个 GCS 组成部分和 GCS 评分创建了散点图和 Bland-Altman 图。结果：筛选并登记了 131 名患者参加研究，其中 15 名患者因违反方案而被排除。在其余 116 名患者中，准确总 GCS 的一致性百分比为 32%（tau-b=0.739；Spearman rho=0.864；Spearman rho(2)=75%）。 GCS 组件的一致性百分比为眼睛 74%（tau-b=0.715；Spearman rho=0.757；Spearman rho(2)=57%），言语 55%（tau-b=0.587；Spearman rho=0.665；Spearman rho(2)=44%），运动 72%（tau-b=0.742；Spearman） rho=0.808；斯皮尔曼 rho(2)=65%)。我们的 Spearman 分析发现，只有大约一半（44% 到 65%）的观察到的方差可以通过配对分量测量之间的关系来解释。对于 GCS 组件，只有 55% 到 74% 的配对测量是相同的，其中 6% 到 17% 相差 2 分或更多分。结论：我们发现 GCS 及其组件只有中等程度的参与者间一致性。
Study objective: Emergency physicians often use the Glasgow Coma Scale (GCS) to help guide decisions in patient care, yet the reliability of the GCS has never been tested in a typical broad sample of emergency department (ED) patients. We determined the interrater reliability of the GCS between emergency physicians when adult patients with altered levels of consciousness are assessed.Methods: In this prospective observational study at a university Level I trauma center, we enrolled a convenience sample of ED patients older than 17 years who presented with an altered level of consciousness. Two residency-trained attending emergency physicians independently assessed and recorded the GCS score and its components (eye, verbal, and motor) in blinded fashion within a 5-minute period. Data were analyzed for interrater reliability by using standard ordinal calculations. We also created scatter plots and Bland-Altman plots for each GCS component and for the GCS score.Results: One hundred thirty-one patients were screened and enrolled in the study, with 15 excluded because of protocol violations. Of the 116 remaining patients, the agreement percentage for exact total GCS was 32% (tau-b=0.739; Spearman rho=0.864; Spearman rho(2)=75%). Agreement percentage for GCS components were eye 74% (tau-b=0.715; Spearman rho=0.757; Spearman rho(2)=57%), verbal 55% (tau-b=0.587; Spearman rho=0.665; Spearman rho(2)=44%), and motor 72% (tau-b=0.742; Spearman rho=0.808; Spearman rho(2)=65%). Our Spearman's analyses found that only approximately half (44% to 65%) of the observed variance could be explained by the relationship between the paired component measures. For GCS components, only 55% to 74% of paired measures were identical, and 6% to 17% of them were 2 or more points apart.Conclusion: We found only moderate degrees of interrater agreement for the GCS and its components.