Haldar Meghna, Verma Ankur, Jaiswal Sanjay, Sheikh Wasil R
Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India.
Indian J Crit Care Med. 2020 Dec;24(12):1198-1200. doi: 10.5005/jp-journals-10071-23603.
Altered mental status (AMS) comprises a group of clinical symptoms rather than a specific diagnosis. A variety of neurological scales have been used to monitor these patients, including the Glasgow coma scale (GCS), AVPU (alert, responds to verbal stimuli, responds to painful stimuli, unresponsive) scale, and ACDU (alert, confused, drowsy, unresponsive) scale. The simplified motor scale (SMS) has been found to be a potential replacement for the GCS. In this study, we compare the interrater reliability of the GCS (individual components), AVPU, ACDU, and SMS to patients presenting to the ED with AMS.
This was a prospective observational study conducted in the emergency department of an urban tertiary-care hospital in New Delhi, India. Patients with AMS (traumatic and nontraumatic) presenting to the ED were assessed by two emergency physicians within 10 minutes of each other using the four neurological scales. Percentage agreement and kappa coefficient score were used to determine interrater reliability for SMS, individual components of GCS, AVPU, and ACDU.
The SMS had the best inter-rater percent agreement with 83.91% (95% CI 77.7-88.6%), followed by ACDU which was 76.44% (95% CI 69.0-81.6%), AVPU 75.29% (95% CI 67.8-80.6%), GCS Eye 74.14% (95% CI 66.6-79.6%), GCS Verbal 67.82% (95% CI 60.6-74.3%), and GCS Motor was 64.94% (95% CI 57.6-71.6%).The kappa coefficient for SMS was 0.75 (95% CI 0.67-0.83), followed by GCS Eye which was 0.63 (95% CI 0.54-0.72), AVPU 0.62 (95% CI 0.52-0.72), ACDU 0.60 (95% CI 0.49-0.71), and GCS Verbal 0.58 (0.49-0.66) and GCS Motor was 0.53 (95% CI 0.44-0.63).
It can be said that SMS has the best interrater reliability in the ED and can be recommended for clinical use in the emergency departments for patients presenting with AMS.
Haldar M, Verma A, Jaiswal S, Sheikh WR. Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department. Indian J Crit Care Med 2020;24(12):1198-1200.
精神状态改变（AMS）包含一组临床症状，而非特定诊断。多种神经学量表已被用于监测这些患者，包括格拉斯哥昏迷量表（GCS）、AVPU（清醒、对言语刺激有反应、对疼痛刺激有反应、无反应）量表以及ACDU（清醒、意识模糊、嗜睡、无反应）量表。简化运动量表（SMS）已被发现可能替代GCS。在本研究中，我们比较了GCS（各单项）、AVPU、ACDU和SMS在因AMS就诊于急诊科患者中的评分者间信度。
这是一项在印度新德里一家城市三级医疗医院急诊科进行的前瞻性观察研究。两名急诊医生在彼此间隔10分钟内，使用四种神经学量表对因AMS（创伤性和非创伤性）就诊于急诊科的患者进行评估。百分比一致性和kappa系数评分用于确定SMS、GCS各单项、AVPU和ACDU的评分者间信度。
SMS的评分者间百分比一致性最佳，为83.91%（95%可信区间77.7 - 88.6%），其次是ACDU，为76.44%（95%可信区间69.0 - 81.6%），AVPU为75.29%（95%可信区间67.8 - 80.6%），GCS眼睛项为74.14%（95%可信区间66.6 - 79.6%），GCS言语项为67.82%（95%可信区间60.6 - 74.3%），GCS运动项为64.94%（95%可信区间57.6 - 71.6%）。SMS的kappa系数为0.75（95%可信区间0.67 - 0.83），其次是GCS眼睛项，为0.63（95%可信区间0.54 - 0.72），AVPU为0.62（95%可信区间0.52 - ；0.72），ACDU为0.60（95%可信区间0.49 - 0.7），GCS言语项为0.58（0.49 - 0.66），GCS运动项为0.53（95%可信区间0.44 - 0.63）。
可以说，SMS在急诊科具有最佳的评分者间信度，可推荐用于急诊科中出现AMS的患者的临床应用。
Haldar M, Verma A, Jaiswal S, Sheikh WR. 四种神经学量表在急诊科患者中的评分者间信度。《印度重症医学杂志》2020；24(12):1198 - 1200。
