Meredith W, Rutledge R, Fakhry S M, Emery S, Kromhout-Schiro S
North Carolina Baptist Hospital, Chapel Hill, USA.
J Trauma. 1998 May;44(5):839-44; discussion 844-5. doi: 10.1097/00005373-199805000-00016.
The Glasgow Coma Scale (GCS), which is the foundation of the Trauma Score, Trauma and Injury Severity Score, and the Acute Physiology and Chronic Health Evaluation scoring systems, requires a verbal response. In some series, up to 50% of injured patients must be excluded from analysis because of lack of a verbal component for the GCS. The present study extends previous work evaluating derivation of the verbal score from the eye and motor components of the GCS.
Data were obtained from a state trauma registry for 24,565 unintubated patients. The eye and motor scores were used in a previously published regression model to predict the verbal score: Derived Verbal Score = -0.3756 + Motor Score * (0.5713) + Eye Score * (0.4233). The correlation of the actual and derived verbal and GCS scales were assessed. In addition the ability of the actual and derived GCS to predict patient survival in a logistic regression model were analyzed using the PC SAS system for statistical analysis. The predictive power of the actual and the predicted GCS were compared using the area under the receiver operator characteristic curve and Hosmer-Lemeshow goodness-of-fit testing.
A total of 24,085 patients were available for analysis. The mean actual verbal score was 4.4 +/- 1.3 versus a predicted verbal score of 4.3 +/- 1.2 (r = 0.90, p = 0.0001). The actual GCS was 13.6 + 3.5 versus a predicted GCS of 13.7 +/- 3.4 (r = 0.97, p = 0.0001). The results of the comparison of the prediction of survival in patients based on the actual GCS and the derived GCS show that the mean actual GCS was 13.5 + 3.5 versus 13.7 + 3.4 in the regression predicted model. The area under the receiver operator characteristic curve for predicting survival of the two values was similar at 0.868 for the actual GCS compared with 0.850 for the predicted GCS.
The previously derived method of calculating the verbal score from the eye and motor scores is an excellent predictor of the actual verbal score. Furthermore, the derived GCS performed better than the actual GCS by several measures. The present study confirms previous work that a very accurate GCS can be derived in the absence of the verbal component.
格拉斯哥昏迷量表（GCS）是创伤评分、创伤和损伤严重程度评分以及急性生理与慢性健康状况评价评分系统的基础，该量表需要患者有言语反应。在一些研究系列中，由于缺乏GCS的言语部分，高达50%的受伤患者必须被排除在分析之外。本研究扩展了先前的工作，评估从GCS的眼部和运动部分得出言语评分的方法。
数据来自一个州创伤登记处的24565例未插管患者。眼部和运动评分用于先前发表的回归模型中以预测言语评分：推导言语评分 = -0.3756 + 运动评分×(0.5713) + 眼部评分×(0.4233)。评估实际和推导的言语及GCS量表之间的相关性。此外，使用PC SAS系统进行统计分析，分析实际和推导的GCS在逻辑回归模型中预测患者生存的能力。使用受试者工作特征曲线下面积和Hosmer-Lemeshow拟合优度检验比较实际和预测的GCS的预测能力。
共有24085例患者可供分析。实际言语评分的平均值为4.4±1.3，而预测言语评分为4.3±1.2（r = 0.90，p = 0.0001）。实际GCS为13.6 + 3.5，而预测GCS为13.7±3.4（r = 0.97，p = 0.0001）。基于实际GCS和推导GCS对患者生存预测的比较结果显示，在回归预测模型中，实际GCS的平均值为13.5 + 3.5，而推导GCS为13.7 + 3.4。预测生存的两个值的受试者工作特征曲线下面积相似，实际GCS为0.868，预测GCS为0.850。
先前从眼部和运动评分计算言语评分的方法是实际言语评分的优秀预测指标。此外，推导的GCS在多项指标上比实际GCS表现更好。本研究证实了先前的工作，即在没有言语部分的情况下可以得出非常准确的GCS。
