Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
Ann Emerg Med. 2011 Nov;58(5):417-25. doi: 10.1016/j.annemergmed.2011.05.033. Epub 2011 Jul 30.
The Glasgow Coma Scale (GCS) score is widely used to assess patients with head injury but has been criticized for its complexity and poor interrater reliability. A 3-point Simplified Motor Score (SMS) (defined as obeys commands=2, localizes pain=1, and withdraws to pain or worse=0) was created to address these limitations. Our goal is to validate the SMS in the out-of-hospital setting, with the hypothesis that it is equivalent to the GCS score for discriminating brain injury outcomes.
This was a secondary analysis of an urban Level I trauma registry. Four outcomes and their composite were studied: emergency tracheal intubation, clinically meaningful brain injury, need for neurosurgical intervention, and mortality. The out-of-hospital GCS score and SMS were evaluated by comparing areas under the receiver operating characteristic curve with a paired nonparametric approach. Multiple imputation was used for missing data. A clinically significant difference in areas under the receiver operating characteristic curve was defined as greater than or equal to 0.05, according to previous literature.
We included 19,408 patients, of whom 18% were tracheally intubated, 18% had brain injuries, 8% required neurosurgical intervention, and 6% died. The difference between the area under the receiver operating characteristic curve for the out-of-hospital GCS score and SMS was 0.05 (95% confidence interval [CI] -0.01 to 0.11) for emergency tracheal intubation, 0.05 (95% CI 0 to 0.09) for brain injury, 0.04 (95% CI -0.01 to 0.09) for neurosurgical intervention, 0.08 (95% CI 0.02 to 0.15) for mortality, and 0.05 (95% CI 0 to 0.10) for the composite outcome.
In this external validation, SMS was similar to the GCS score for predicting outcomes in traumatic brain injury in the out-of-hospital setting.
格拉斯哥昏迷评分（GCS）广泛用于评估头部受伤的患者，但因其复杂性和观察者间可靠性差而受到批评。创建了 3 分简化运动评分（SMS）（定义为服从命令=2、定位疼痛=1、对疼痛或更严重的刺激退缩=0）来解决这些限制。我们的目标是在院外环境中验证 SMS，假设它等同于 GCS 评分，用于区分脑损伤结果。
这是城市一级创伤登记处的二次分析。研究了四个结局及其综合指标：急诊气管插管、有临床意义的脑损伤、需要神经外科干预和死亡率。通过比较接收者操作特征曲线下的面积，使用配对非参数方法评估院外 GCS 评分和 SMS。使用多重插补处理缺失数据。根据先前的文献，定义接收者操作特征曲线下面积的临床显著差异大于或等于 0.05。
我们纳入了 19408 名患者，其中 18%进行了气管插管，18%有脑损伤，8%需要神经外科干预，6%死亡。院外 GCS 评分和 SMS 的接收者操作特征曲线下面积之间的差异为 0.05（95%置信区间 [CI] -0.01 至 0.11），用于急诊气管插管，0.05（95% CI 0 至 0.09），用于脑损伤，0.04（95% CI -0.01 至 0.09），用于神经外科干预，0.08（95% CI 0.02 至 0.15），用于死亡率，0.05（95% CI 0 至 0.10），用于复合结局。
在这项外部验证中，SMS 与 GCS 评分相似，可用于预测院外创伤性脑损伤的结局。
