Bledsoe Bryan E, Casey Michael J, Feldman Jay, Johnson Larry, Diel Scott, Forred Wes, Gorman Codee
1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
2MedicWest Ambulance/American Medical Response,Las Vegas,NevadaUSA.
Prehosp Disaster Med. 2015 Feb;30(1):46-53. doi: 10.1017/S1049023X14001289. Epub 2014 Dec 9.
The Glasgow Coma Scale (GCS) is widely applied in the emergency setting; it is used to guide trauma triage and for the application of essential interventions such as endotracheal intubation. However, inter-rater reliability of GCS scoring has been shown to be low for inexperienced users, especially for the motor component. Concerns regarding the accuracy and validity of GCS scoring between various types of emergency care providers have been expressed. Hypothesis/Problem The objective of this study was to determine the degree of accuracy of GCS scoring between various emergency care providers within a modern Emergency Medical Services (EMS) system.
This was a prospective observational study of the accuracy of GCS scoring using a convenience sample of various types of emergency medical providers using standardized video vignettes. Ten video vignettes using adults were prepared and scored by two board-certified neurologists. Inter-rater reliability was excellent (Cohen's κ = 1). Subjects viewed the video and then scored each scenario. The scoring of subjects was compared to expert scoring of the two board-certified neurologists.
A total of 217 emergency providers watched 10 video vignettes and provided 2,084 observations of GCS scoring. Overall total GCS scoring accuracy was 33.1% (95% CI, 30.2-36.0). The highest accuracy was observed on the verbal component of the GCS (69.2%; 95% CI, 67.8-70.4). The eye-opening component was the second most accurate (61.2%; 95% CI, 59.5-62.9). The least accurate component was the motor component (59.8%; 95% CI, 58.1-61.5). A small number of subjects (9.2%) assigned GCS scores that do not exist in the GCS scoring system.
Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.
格拉斯哥昏迷量表（GCS）在急诊环境中广泛应用；它用于指导创伤分诊以及实施诸如气管插管等必要干预措施。然而，对于缺乏经验的使用者而言，GCS评分的评分者间信度已被证明较低，尤其是运动部分。人们对各类急救护理提供者之间GCS评分的准确性和有效性表示担忧。假设/问题 本研究的目的是确定现代紧急医疗服务（EMS）系统中各类急救护理提供者之间GCS评分的准确程度。
这是一项前瞻性观察性研究，使用标准化视频短片对各类急救医疗提供者的便利样本进行GCS评分准确性研究。准备了10个使用成人的视频短片，并由两名获得董事会认证的神经科医生进行评分。评分者间信度极佳（科恩kappa系数=1）。受试者观看视频，然后对每个场景进行评分。将受试者的评分与两名获得董事会认证的神经科医生的专家评分进行比较。
共有217名急救提供者观看了10个视频短片，并提供了2084次GCS评分观察结果。总体GCS评分总准确率为33.1%（95%置信区间，30.2 - 36.0）。在GCS的语言部分观察到最高准确率（69.2%；95%置信区间，67.8 - 70.4）。睁眼部分是第二准确的（61.2%；95%置信区间，59.5 - 62.9）。最不准确的部分是运动部分（59.8%；95%置信区间，58.1 - 61.5）。少数受试者（9.2%）给出了GCS评分系统中不存在的GCS分数。
格拉斯哥昏迷量表评分不应被视为准确。应开发并验证一个更简化的评分系统。
