Simplified GCS – motor score as good as the whole

August 30, 2016

Short Attention Span Summary

What’s this study about?
Is it just me, or do you have to use MD Calc to calculate the GCS?  It’s hard to do it in your head.  Would it work to just use the GCS – motor component (GCS-m) and know that if <6, i.e. not following commands, it works just as well to predict injury than the full GCS score?  That is exactly what these authors found.  GCS-m predicted as well as the full GCS on almost every measure of injury severity.

Why does this matter?
This could drastically simplify prehospital assessment of trauma patients for determining trauma leveling.  Following commands? Yes = lower risk. No = higher risk.  It’s enough of a cognitive load to rescue a patient from a crash scene and stay safe in the process.  Trying to work out the GCS in your head is even tougher.

Spoon Feed
The most important part of the GCS is the motor part.  Patients who are not following commands are sick and need a trauma center.

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Abstract

Glasgow Coma Scale Motor Component (“Patient Does Not Follow Commands”) Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients.

Ann Emerg Med. 2016 Jul 16. pii: S0196-0644(16)30295-5. doi: 10.1016/j.annemergmed.2016.06.017. [Epub ahead of print]

Ann Emerg Med. 2016 Jul 16. pii: S0196-0644(16)30295-5. doi: 10.1016/j.annemergmed.2016.06.017. [Epub ahead of print]

Glasgow Coma Scale Motor Component (“Patient Does Not Follow Commands”) Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients.

Kupas DF1, Melnychuk EM2, Young AJ3.

Author information:

1Department of Emergency Medicine, Geisinger Health System, Danville, PA. Electronic address: dkupas@geisinger.edu.

2Department of Emergency Medicine, Geisinger Health System, Danville, PA.

3Center for Health Research, Geisinger Health System, Danville, PA.

Abstract

STUDY OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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%).

CONCLUSION:

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.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

PMID: 27436703 [PubMed – as supplied by publisher]