Prehosp Emerg Care. 2014 Jan-Mar;18(1):68-75. doi: 10.3109/10903127.2013.844870.
This study compared the prehospital motor component subscale of the Glasgow Coma Scale (mGCS) to the prehospital total GCS (tGCS) score for its ability to predict the need for intubation, survival to hospital discharge, and neurosurgical intervention in trauma patients.
This is a retrospective analysis of an urban level 1 trauma registry. All trauma patients presenting to the trauma center emergency department via emergency medical services from July 2008 through June 2010 were included. The area under the receiver operating characteristics curve (AUC) analysis was used to compare the predictive ability of the prehospital mGCS to tGCS for three outcomes: intubation, survival to hospital discharge, and neurosurgical intervention. Two subgroups (patients with injury severity score [ISS] ≥ 16 and traumatic brain injury [TBI] [head abbreviated injury score (AIS) ≥ 3]) were analyzed. An a priori statistically significant absolute difference of 0.050 in AUC between mGCS and tGCS for these clinical outcomes was used as a clinically significant difference. Multiple imputation was used for missing prehospital GCS data.
There were 9,816 patients, of which 4% were intubated, 3.8% had neurosurgical intervention, and 97.1% survived to hospital discharge. The absolute difference in AUC (prehospital tGCS minus mGCS) for all cases was statistically significant for all three outcomes but did not reach the clinical significance threshold: survival = 0.010 (95% CI: 0.002-0.018), intubation = 0.018 (95% CI: 0.011-0.024), and neurosurgical intervention = 0.019 (95% CI: 0.007-0.029). The difference in AUC between tGCS and mGCS for the subgroups ISS ≥ 16 (n = 1,151) and TBI (n = 1,165) did not reach clinical significance for the three outcomes. The discriminatory ability of the prehospital mGCS was good for survival (AUC: all patients = 0.89, ISS ≥ 16 = 0.84, traumatic brain injury = 0.86) excellent for intubation (AUC: all patients = 0.95, ISS ≥ 16 = 0.91, traumatic brain injury = 0.91), and poor for neurosurgical intervention (AUC: all patients = 0.67, ISS ≥ 16 = 0.57, traumatic brain injury = 0.60).
The prehospital mGCS appears have good discriminatory power and is equivalent to the prehospital tGCS for predicting intubation and survival to hospital discharge in this trauma population as a whole, those with ISS ≥ 16, or TBI.
本研究比较了创伤患者院前格拉斯哥昏迷量表（GCS）运动成分子量表（mGCS）与院前总 GCS（tGCS）评分对插管需求、出院存活率和神经外科干预的预测能力。
这是一项对城市 1 级创伤登记处的回顾性分析。纳入 2008 年 7 月至 2010 年 6 月通过急诊医疗服务送达创伤中心急诊室的所有创伤患者。使用受试者工作特征曲线下面积（AUC）分析比较 mGCS 和 tGCS 对以下三种结局的预测能力：插管、出院存活率和神经外科干预。分析了两个亚组（损伤严重程度评分[ISS]≥16 和创伤性脑损伤[TBI][头部简略损伤评分（AIS）≥3]）。将 mGCS 和 tGCS 之间 AUC 的临床显著绝对差异（0.050）用于这三个临床结局作为临床显著差异。使用多重插补法处理院前 GCS 数据缺失。
共纳入 9816 例患者，其中 4%插管，3.8%接受神经外科干预，97.1%出院存活。所有病例的 AUC（院前 tGCS 减去 mGCS）绝对差值在所有三种结局上均有统计学意义，但未达到临床显著阈值：存活率=0.010（95%CI：0.002-0.018），插管=0.018（95%CI：0.011-0.024），神经外科干预=0.019（95%CI：0.007-0.029）。ISS≥16（n=1151）和 TBI（n=1165）亚组的 tGCS 和 mGCS 之间 AUC 的差异在三种结局中均无统计学意义。院前 mGCS 对生存率（AUC：所有患者=0.89，ISS≥16=0.84，创伤性脑损伤=0.86）的鉴别能力良好，对插管（AUC：所有患者=0.95，ISS≥16=0.91，创伤性脑损伤=0.91）的鉴别能力极好，对神经外科干预（AUC：所有患者=0.67，ISS≥16=0.57，创伤性脑损伤=0.60）的鉴别能力较差。
在本创伤人群中，整体、ISS≥16 或 TBI 患者，mGCS 似乎具有良好的鉴别能力，与院前 tGCS 预测插管和出院存活率相当。
