Rowley G, Fielding K
School of Graduate Studies, Faculty of Education, Monash University, Melbourne, Victoria, Australia.
Lancet. 1991 Mar 2;337(8740):535-8. doi: 10.1016/0140-6736(91)91309-i.
To investigate whether the Glasgow Coma Scale (GCS) can be used reliably and accurately by inexperienced observers, ratings made by observers grouped by level of experience were examined for within-group interobserver disagreements and for discrepancies with scores given by an expert. The GCS was used accurately by experienced and highly trained users, but inexperienced users made consistent errors. The errors were such that they would not be detectable by studies that examine only interobserver agreement, and they were substantial, averaging in some cases more than one point on the four-point and five-point scales of the GCS. Also, the error rates were highest at the intermediate levels of consciousness, for which the detection of changes in condition is vital. The findings support the continued use of the GCS by appropriately qualified personnel, but call into question much of the conventional wisdom about its reliability when used by untrained or inexperienced staff. The findings also suggest that interobserver comparisons are insufficient for establishing the viability of the GCS.
为了研究经验不足的观察者能否可靠且准确地使用格拉斯哥昏迷量表（GCS），对按经验水平分组的观察者所做的评分进行了检查，以分析组内观察者间的分歧以及与专家给出分数的差异。经验丰富且训练有素的使用者能够准确使用GCS，但经验不足的使用者会出现一致性错误。这些错误仅通过检查观察者间一致性的研究是无法检测到的，而且这些错误很严重，在某些情况下，在GCS的四分制和五分制量表上平均超过一分。此外，在意识的中间水平，错误率最高，而在这一水平对病情变化的检测至关重要。这些发现支持具备适当资质的人员继续使用GCS，但对于未经培训或经验不足的工作人员使用该量表时的可靠性，许多传统观念受到了质疑。这些发现还表明，观察者间的比较不足以确定GCS的可行性。
