Glasgow coma scale for field triage of trauma a systematic review
OBJECTIVES: To assess the predictive utility, reliability, and ease of use of the total Glasgow Coma Scale (tGCS) versus the motor component of the Glasgow Coma Scale (mGCS) for field triage of trauma, and effects on clinical decisionmaking and clinical outcomes. DATA SOURCES: MEDLINE(r), CINAHL(r),...
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| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
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Rockville, MD
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
2017, January 2017
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| Series: | Comparative effectiveness review
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | OBJECTIVES: To assess the predictive utility, reliability, and ease of use of the total Glasgow Coma Scale (tGCS) versus the motor component of the Glasgow Coma Scale (mGCS) for field triage of trauma, and effects on clinical decisionmaking and clinical outcomes. DATA SOURCES: MEDLINE(r), CINAHL(r), PsycINFO(r), HaPI (Health and Psychosocial Instruments), the Cochrane Databases (January 1995 through June 2016), and reference lists. STUDY SELECTION: Studies on predictive utility of the tGCS versus the mGCS or Simplified Motor Scale (SMS), randomized trials and cohort studies on effects of the tGCS versus the mGCS on rates of over- or under-triage, and studies on interrater reliability and ease of use. DATA EXTRACTION: One investigator abstracted study characteristics and results; a second checked data for accuracy. Two investigators independently applied prespecified criteria to rate study quality. Data on discrimination were pooled using a random effects model. All predictive utility studies were retrospective, and mGCS and SMS were taken from tGCS rather than independently assessed. Most studies had methodological limitations. We included only English-language studies and were limited in our ability to assess publication bias. Studies on ease of use focused on scoring of video or written patient scenarios. CONCLUSIONS: The tGCS is associated with slightly greater discrimination than the mGCS or SMS for in-hospital mortality, receipt of neurosurgical interventions, severe brain injury, and emergency intubation. The clinical significance of small differences in discrimination is likely to be small and could be offset by factors such as convenience and ease of use. Research is needed to understand how use of the tGCS versus the mGCS or SMS impacts clinical outcomes and risk of over- or under-triage The tGCS is also associated with greater discrimination than the mGCS or SMS for receipt of neurosurgical interventions, severe brain injury, and emergency intubation (differences in AUROC from 0.03 to 0.05; SOE: Moderate). Differences in discrimination between mGCS and SMS were very small. Findings were robust in sensitivity and subgroup analyses. Differences among the tGCS, mGCS, and SMS in diagnostic accuracy (sensitivity, specificity) using standard thresholds were small, based on limited evidence (SOE: Low). Evidence was insufficient to determine if there were differences between the tGCS and the mGCS in interrater reliability (SOE: Insufficient). Three studies found that the tGCS was associated with lower proportions of correct scores than the mGCS; differences ranged from 6 percent to 27 percent (SOE: Low). LIMITATIONS: Evidence on comparative predictive utility was primarily restricted to effects on discrimination. The strength of evidence was graded using published methods. RESULTS: Thirty-two studies met inclusion criteria; 24 studies addressed predictive utility and 10 addressed interrater reliability or ease of use. No study assessed comparative effects on over- or under-triage or clinical outcomes. For in-hospital mortality, the tGCS is associated with slightly greater discrimination than the mGCS (pooled mean difference in area under the receiver operating characteristic curve [AUROC], 0.015; 95% confidence interval [CI], 0.009 to 0.022; I2 = 85%; 12 studies; strength of evidence [SOE]: Moderate) or the SMS (pooled mean difference in AUROC, 0.030; 95% CI, 0.024 to 0.036; I2 = 0%; 5 studies; SOE: Moderate). This means that for every 100 trauma patients, the tGCS correctly discriminates 1 to 3 more cases of in-hospital mortality from cases without in-hospital mortality than the mGCS or SMS. |
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| Item Description: | "Effective Health Care Program" --Cover |
| Physical Description: | 1 PDF file (various pagings) illustrations |