Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-13T03:09:32.369Z Has data issue: false hasContentIssue false
  • English
  • Français

Precision and Reliability of the Glasgow Coma Scale Score among a Cohort of Latin American Prehospital Emergency Care Providers

Published online by Cambridge University Press:  28 June 2012

Amado Alejandro Báez ,
Ediza M. Giráldez  and
Julio M. De Peña
Amado Alejandro Báez*
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic
Ediza M. Giráldez
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic
Julio M. De Peña
Affiliation:
Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic Department of Emergency Medicine, University of Puerto Rico, San Juan, Puerto Rico
*
Amado Alejandro Báez Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115USA Email: aabaez@partners.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness in patients with head injuries.Rapid and accurate GCS scoring is essential for adequate assessment and treatment of critically sick and injured patients. This study sought out to determine the precision and reliability of the GCS among a cohort of Latin American Critical Care Transport Providers.

Methods:

The study consisted of a cross-sectional design using an Internetbased examination. The evaluation consisted of four focused clinical scenarios with a classification based on severity. For measurement of intra-rater reliability the first and fourth cases were identical. Five minutes were allocated for each scenario. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations. For all tests, statistical significance was set at the 0.05 level.

Results:

A total of 62 providers participated, including 17 physicians and 45 advanced providers (nurses and paramedics). No statistically significant differences were observed between physicians and advanced providers in the correct classification of the individual scenarios. Five of the 17 physicians (29.4%) answered all cases correctly, while none of the 45 advanced providers did (p <0.001). When evaluating the duplicated cases (Cases 1 and 4), five physicians (29.4%) and 11 advanced providers (24.4%) correctly classified the cases. This difference was not statistically significant.

Conclusions:

This study demonstrated a poor precision and poor reliability in the use of the Glasgow Coma Scale within the study subjects.

Keywords

Emergency Medical ServicesGlasgow Coma ScaleinjuryLatin Americaprehospitaltrauma
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 3 , June 2007 , pp. 230 - 232
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Teasdale, G, Jennett, B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–84.Google ScholarPubMed
2.Teasdale, G, Jennett, B: Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 1976;34(1–4):45–55.Google Scholar
3.American College of Surgeons (ACS) Committee on Trauma: Resources for the Optimal Care of the Injured Patient: 1999. Chicago: American College of Surgeons, 1998.Google Scholar
4.Champion, HR, Sacco, WJ, Carnazzo, AJ, Copes, W, Fouty, WJ:Trauma score. Crit Care Med 1981;9(9):672–676.Google Scholar
5.Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME: A revision of the Trauma Score. J Trauma 1989;29(5):623–629.Google Scholar
6.Chesnut, RM: The management of severe traumatic brain injury. Emerg Med Clin Am 1997;15(3):581–604.Google Scholar
7.Gormican, SP: CRAMS scale: Field triage of trauma victims. Ann Emerg Med 1982;11(3):132–135.CrossRefGoogle ScholarPubMed
8.Boyd, CR, Tolson, MA, Copes, WS: Evaluating trauma care:The TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987;27(4):370–378.CrossRefGoogle ScholarPubMed
9.Knaus, WA, Zimmerman, JE, Wagner, DP, Draper, EA, Lawrence, DE: APACHE-acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981;9(8):591–597.CrossRefGoogle ScholarPubMed
10.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.Google Scholar
11.Bastos, PG, Sun, X, Wagner, DP, Wu, AW, Knaus, WA: Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: Findings from the acute physiology and chronic health evaluation III study. Crit Care Med 1993;21(10):1459–1465.CrossRefGoogle ScholarPubMed
12.White, JR, Farukhi, Z, Bull, C, Christensen, J, Gordon, T, Paidas, C, Nichols, DG: Predictors of outcome in severely head-injured children. Crit Care Med 2001;29(3):534–540.Google Scholar
13.Winkler, JV, Rosen, P, Alfry, EJ: Prehospital use of the Glasgow Coma Scale in severe head injury. J Emerg Med 1984;2(1):1–6.Google Scholar
14.Crossman, J, Bankes, M, Bhan, A, Crockard HA: The Glasgow Coma Score: Reliable evidence? Injury 1998;29(6):435–437.CrossRefGoogle ScholarPubMed
15.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
16.Rowley, G, Fielding, K: Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet 1991;337(8740):535–538.CrossRefGoogle ScholarPubMed
17.Lane, PL, Baez, AA, Brabson, T, Burmeister, DD, Kelly, JJ: Effectiveness of a Glasgow Coma Scale instructional video for EMS providers. Prehosp Disast Med 2002;17(3):142–146.Google Scholar