Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
Emerg Med J. 2012 Jun;29(6):492-6. doi: 10.1136/emj.2010.110437. Epub 2011 Jul 27.
The simplified motor score (SMS) is a three-point measure of traumatic brain injury (TBI) severity, which is easier to calculate than the 15-point Glasgow coma scale (GCS). Using a state trauma registry, the accuracy of the emergency medical services (EMS)-obtained SMS was compared with the GCS for predicting neurological outcomes and mortality.
A retrospective, observational analysis was performed of patients aged 16 years and older in the 2002-7 Ohio Trauma Registry. Those not initially transported by EMS or with incomplete EMS GCS scores were excluded. Outcomes included inhospital mortality, TBI, neurosurgical intervention, any emergency intubation and emergency department intubation. Discriminatory ability was compared using area under the receiver-operating characteristic curves (AUC). Sensitivity and specificity for each outcome were calculated at a SMS cutoff of one or less (any abnormal SMS) and a GCS cutoff of 13 or less.
52,412 patients were identified. Sensitivity, specificity and AUC were similar between the SMS and GCS for all outcomes. Sensitivity for mortality was 72.2% for SMS and 74.6% for GCS. Sensitivity for TBI was 40.8% for SMS and 45.4% for GCS. Sensitivity for neurosurgical intervention was 52.9% for SMS and 60.0% for GCS. Sensitivity for any intubation was 72.7% for SMS and 75.5% for GCS. Specificity was less than 2% different for all outcomes. Discriminatory ability was similar with the difference in AUC between SMS and GCS no greater than 6% for any outcome.
In a state trauma registry including both trauma and non-trauma centres, the EMS-obtained SMS performs as well as the 15-point GCS.
简化运动评分（SMS）是一种三点法评估创伤性脑损伤（TBI）严重程度的指标，其计算难度低于 15 分的格拉斯哥昏迷评分（GCS）。利用州创伤登记处，比较了急救医疗服务（EMS）获得的 SMS 与 GCS 在预测神经结局和死亡率方面的准确性。
对 2002-2007 年俄亥俄州创伤登记处年龄在 16 岁及以上的患者进行回顾性、观察性分析。排除最初未由 EMS 转运或 EMS GCS 评分不完整的患者。结局包括院内死亡率、TBI、神经外科干预、任何急诊插管和急诊部插管。使用受试者工作特征曲线下面积（AUC）比较判别能力。计算 SMS 截点为 1 或更低（任何异常 SMS）和 GCS 截点为 13 或更低时每个结局的敏感性和特异性。
共确定了 52412 例患者。SMS 和 GCS 在所有结局中的敏感性、特异性和 AUC 相似。SMS 对死亡率的敏感性为 72.2%，GCS 为 74.6%。SMS 对 TBI 的敏感性为 40.8%，GCS 为 45.4%。SMS 对神经外科干预的敏感性为 52.9%，GCS 为 60.0%。SMS 对任何插管的敏感性为 72.7%，GCS 为 75.5%。所有结局的特异性差异小于 2%。AUC 之间的差异小于 6%，提示判别能力相似。
在包括创伤和非创伤中心的州创伤登记处中，EMS 获得的 SMS 与 15 分的 GCS 表现相当。
