Department of Neurosurgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
University of Antwerp, Edegem, Belgium.
Intensive Care Med. 2016 Jan;42(1):3-15. doi: 10.1007/s00134-015-4124-3. Epub 2015 Nov 12.
The Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS.
A literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively.
We identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85%, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used.
Only 13% of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required.
格拉斯哥昏迷评分（GCS）提供了一种评估意识水平的结构化方法。其衍生的总分被应用于研究和重症监护病房评分系统中。GCS 的可靠性存在争议。本系统评价的目的是总结 GCS 可靠性的证据。
在 MEDLINE、EMBASE 和 CINAHL 中进行了文献检索。纳入了评估 GCS 可靠性的观察性研究，其可靠性用统计指标表示。使用共识标准评估方法学质量选择健康测量仪器检查表及其对结果的影响被认为是有影响的。可靠性估计值以叙述性方式综合。
我们确定了 52 项相关研究，这些研究在使用的可靠性估计类型、研究对象、观察对象的设置和特征方面存在显著异质性。方法学质量良好（n = 7）、中等（n = 18）或较差（n = 27）。在高质量的研究中，kappa 值≥0.6 的占 85%，所有组内相关系数均表明可靠性良好。低质量的研究显示出较低的可靠性估计值。GCS 各成分的可靠性高于总分的可靠性。可能影响可靠性的因素包括教育和培训、意识水平和使用的刺激类型。
只有 13%的研究质量良好，且报告的可靠性估计值不一致。尽管高质量研究中的可靠性足够，但仍需要进一步提高。从方法学的角度来看，可靠性研究的质量需要提高。从临床角度来看，需要重新关注培训/教育和评估的标准化。
