Cited by 231Trauma and Emergency Care StudiesTraumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury Research

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PROBLEMS WITH INITIAL GLASGOW COMA SCALE ASSESSMENT CAUSED BY PREHOSPITAL TREATMENT OF PATIENTS WITH HEAD INJURIES: RESULTS OF A NATIONAL SURVEY

Marion, Donald W., Carlier, Patricia M.·1994·The Journal of Trauma: Injury, Infection, and Critical Care

DOI 10.1097/00005373-199401000-00014

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Abstract

The rapid treatment of patients with a severe head injury often includes prehospital intubation and sedation, but such measures compromise the ability to obtain an accurate Glasgow Coma Scale (GCS) score in the emergency department (ED). Major head injury centers in the United States were surveyed to determine how they currently obtain initial GCS scores when these or other complicating circumstances exist. A two-page questionnaire was distributed to seven members of the trauma team at 17 major neurotrauma centers in which they were asked who usually determines the initial GCS scores, where they are assessed, and when. Respondents were also asked how they assign scores for patients who received medications or were intubated before arrival at their hospital and how they score patients who are hypotensive, hypoxic, or have severe periorbital swelling. Most centers assess the initial GCS scores in their ED within 1 hour after the discovery of the patient by prehospital personnel. Most neurosurgeons said that hypotension and hypoxia are stabilized before the initial GCS scores are assessed and that intubated patients receive a non-numerical designation. But the majority of non-neurosurgical ED personnel said that they determine the initial GCS scores immediately after arrival of the patients in their department, regardless of hypoxia or hypotension. There also were significant discrepancies between attending neurosurgeons and their residents with regard to who actually assesses the GCS scores and how the scores are determined for patients who have received neuromuscular paralysis or sedation or who have severe periorbital swelling. In addition, 20% of attending neurosurgeons and 24% of non-neurosurgical ED personnel reported using the worst, rather than the best, GCS sum score when motor or eye-opening abilities are asymmetrical. This survey revealed important inter-center and intra-center differences of opinion regarding how the initial GCS scores are obtained. Such differences make it difficult to interpret the results of head injury studies that use the initial GCS scores to describe injury severity. The results of this survey emphasize the need for nationally recognized policies for determining the initial GCS scores that account for contemporary prehospital management of patients with severe head injuries.

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Kerby, J. D., MacLennan, P. A., Burton, J. N., et al. (2007) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e318157d9e8 · Cited by 65
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Shore, P. M., Berger, R. P., Varma, S., Janesko, K. L., Wisniewski, S. R., Clark, R. S. B., Adelson, P. D., Thomas, N. J., Lai, Y., Bayır, H., et al. (2007) · Journal of Neurotrauma · doi:10.1089/neu.2006.0062 · Cited by 62
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Thompson, D. O., Hurtado, T. R., Liao, M. M., Byyny, R. L., Gravitz, C. S., & Haukoos, J. S. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2011.05.033 · Cited by 62
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Nell, V., Yates, D., & Kruger, J. (2000) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(00)90044-3 · Cited by 61
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Campbell, C., Kuehn, S. M., Richards, P. M., Ventureyra, E. C. G., & Hutchison, J. S. (2004) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100053853 · Cited by 61
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“Since there is no standard approach for assessing the motor component of the GCS among patients who are chemically paralysed [55], the number of severe patients in the sample may have been over-estimated by using this approach.”
Method
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Chesnut, R. M. (2007) · Surgical Clinics of North America · doi:10.1016/j.suc.2006.09.018 · Cited by 54
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Chen, A. Y., Zagorski, B., Parsons, D., Laan, R. V., Chan, V., & Colantonio, A. (2012) · BMC Neurology · doi:10.1186/1471-2377-12-16 · Cited by 51
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Shore, P. M., Hand, L. L., Roy, L., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000220765.22184.ed · Cited by 50
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Background
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Regner, A., Kaufman, M., Friedman, G., et al. (2001) · Neuroreport · doi:10.1097/00001756-200103260-00015 · Cited by 49
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(2000) · Journal of Neurotrauma · doi:10.1089/neu.2000.17.563 · Cited by 49
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Suskauer, S. J., Slomine, B. S., Inscore, A. B., et al. (2009) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-2009-0092 · Cited by 47
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Namiki, J., Yamazaki, M., Funabiki, T., et al. (2011) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2011.01.001 · Cited by 46
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Gómez, P. A., de la Cruz, J., Lora, D., Roldan, L. J., Rodríguez-Boto, G., Sarabia, R., Sahuquillo, J., Lastra, R., Morera, J., Lazo-Fernández, E., et al. (2014) · Journal of neurosurgery · doi:10.3171/2014.7.jns131874 · Cited by 45
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Moore, L., Hanley, J. A., Turgeon, A. F., Lavoie, A., & Eric, B. (2010) · Annals of Surgery · doi:10.1097/sla.0b013e3181d97589 · Cited by 42
Poor outcome after hypoxia-ischemia in newborns is associated with physiological abnormalities during early recovery. Possible relevance to secondary brain injury after head trauma in infants.
Brambrink, A., Ichord, R., Martin, L. J., Koehler, R., & Traystman, R. (1999) · Experimental and Toxicological Pathology · doi:10.1016/s0940-2993(99)80089-x · Cited by 50
Coma scales: a historical review
Bordini, A. L., Luiz, T. F., Fernandes, M., et al. (2010) · Arquivos de Neuro-Psiquiatria · doi:10.1590/s0004-282x2010000600019 · Cited by 43
Survival of trauma patients with coma and bilateral fixed dilated pupils
Chaudhuri, K., Malham, G. M., & Rosenfeld, J. V. (2008) · Injury · doi:10.1016/j.injury.2008.09.004 · Cited by 42
Disability and health-related quality-of-life 4 years after a severe traumatic brain injury: A structural equation modelling analysis
Azouvi, P., Ghout, I., Bayen, É., Darnoux, E., Azerad, S., Ruet, A., Vallat‐Azouvi, C., Pradat-Diehl, P., Aegerter, P., Charanton, J., et al. (2016) · Brain Injury · doi:10.1080/02699052.2016.1201593 · Cited by 41
“The GCS was not included in the model either, as it was considered that, although it represents an important predictor of functional outcome after TBI, variability in pre-hospital care and timing of attainment of GCS may impact assigned scores [18].”
Background
Management of brain and spine injuries
Chesnut, R. M. (2004) · Critical Care Clinics · doi:10.1016/s0749-0704(03)00090-3 · Cited by 41
“Authors have presented data suggesting that the GCS routinely is performed poorly and is often inaccurate when performed in the prehospital setting [20].”
Background
The Glasgow Coma Scale: History and current practice
Jennett, B. (2002) · Trauma · doi:10.1191/1460408602ta233oa · Cited by 41
Association of injury severity, MRI-results and ApoE genotype with 1-year outcome in mainly mild TBI: A preliminary study
Hiekkanen, H., Kurki, T. J. I., Brandstack, N., Kairisto, V., & Tenovuo, O. S. (2009) · Brain Injury · doi:10.1080/02699050902926259 · Cited by 40
A comparison of the Full Outline of UnResponsiveness (FOUR) score and Glasgow Coma Score (GCS) in predictive modelling in traumatic brain injury
Kasprowicz, M., Burzyńska, M., Melcer, T., & Kübler, A. (2016) · British Journal of Neurosurgery · doi:10.3109/02688697.2016.1161173 · Cited by 40
MODERATE HEAD INJURY: A SYSTEM OF NEUROTRAUMA CARE
Fearnside, M. R., & Mcdougall, P. (1998) · Australian and New Zealand Journal of Surgery · doi:10.1111/j.1445-2197.1998.tb04638.x · Cited by 39
Evidence-based improvement of the National Trauma Triage Protocol
Brown, J. B., Forsythe, R. M., Stassen, N. A., et al. (2014) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000000280 · Cited by 37
“There has been significant variation in the way these situations are handled between centers, preventing accurate comparisons among studies and patients.(21,22) The GCS is a complex scale that takes more than a few seconds to assess.”
Background
Development of the American association of critical-care nurses' sedation assessment scale for critically ill patients.
Jong, M. M. J. D., Burns, S. M., Campbell, M., Chulay, M., Grap, M. J., Pierce, L. N. B., & Simpson, T. (2005) · PubMed · Cited by 38
Assessing Quality of Care in a Trauma Referral Center: Benchmarking Performance by TRISS-Based Statistics or by Analysis of Stratified ISS Data?
Skaga, N. O., Eken, T., & Steen, P. A. (2006) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000205613.52586.d1 · Cited by 35
Prise en charge préhospitalière des traumatisés crâniens
Rouxel, J.-M.-P., Tazarourte, K., Moigno, S. L., et al. (2003) · Annales Françaises d Anesthésie et de Réanimation · doi:10.1016/j.annfar.2003.09.021 · Cited by 35
Panel of serum protein biomarkers to grade the severity of traumatic brain injury
Anada, R. P., Wong, K. T., Jayapalan, J. J., Hashim, O. H., & Ganesan, D. (2018) · Electrophoresis · doi:10.1002/elps.201700407 · Cited by 34
Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood
Heather, N. L., Derraik, J. G. B., Beca, J., Hofman, P. L., Dansey, R., Hamill, J., & Cutfield, W. S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0082245 · Cited by 34
“However, GCS scores are subject to a number of limitations, including inter-observer reliability [4-6], time elapsed since injury, as well as the confounding effects of seizures, early sedation or intubation, and physiological shock [7].”
A New “TRISS-Like” Probability of Survival Model for Intubated Trauma Patients
Davis, E. G., MacKenzie, E. J., Sacco, W. J., et al. (2003) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000075340.22097.b5 · Cited by 34
Traumatic Brain Injury Research: A Review of Clinical Studies
Lovasik, D. A., Kerr, M. E., & Alexander, S. A. (2001) · Critical Care Nursing Quarterly · doi:10.1097/00002727-200102000-00003 · Cited by 33
S-100 Serum Levels and Outcome After Severe Head Injury
Rothoerl, R. D., Woertgen, C., & Brawanski, A. T. (2000) · Springer eBooks · doi:10.1007/978-3-7091-6346-7_20 · Cited by 32
Classification of a traumatic brain injury: the Glasgow Coma scale is not enough
Chieregato, A., Martino, C., Pransani, V., NORI, G., Russo, E., Noto, A., & Simini, B. (2010) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.2010.02234.x · Cited by 31
How Well Do Neurosurgeons Care for Trauma Patients? A Survey of the Membership of the American Association for the Surgery of Trauma
Valadka, A. B., Andrews, B. T., & Bullock, M. R. (2001) · Neurosurgery · doi:10.1097/00006123-200101000-00004 · Cited by 31
“In some other surveys of this type that report higher response rates, the populations surveyed were much smaller than the one surveyed here (7, 9), thereby facilitating repeat mailings and other methods of capturing nonresponders.”
Result
Predicting intracranial hemorrhage after traumatic brain injury in low and middle-income countries: A prognostic model based on a large, multi-center, international cohort
Subaiya, S., Roberts, I., Komolafe, E., & Perel, P. (2012) · BMC Emergency Medicine · doi:10.1186/1471-227x-12-17 · Cited by 36
“This could be attributed to those patients that have been sedated and intubated prior to recording of GCS, as these are given a score of three by default [27].”
Background

Authors: Marion, D. W., & Carlier, P. M.
Affiliations: University of Pittsburgh (US)
ORCID: Marion, Donald W.
Venue: The Journal of Trauma: Injury, Infection, and Critical Care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1994-01
Volume: 36
Issue: 1
Pages: 89-95
ISSN: 0022-5282 (ISSN-L)
DOI: 10.1097/00005373-199401000-00014
OpenAlex: W1965352548
Cited by: 226
References: 0
Citations by year: 2026: 2 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 7 · 2015: 4 · 2014: 7 · 2013: 5 · 2012: 15
FWCI: 6.57
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5p20ns030318-03)
National Institute of Neurological Disorders and Stroke (NINDS 1P20NS30318-01)
Topics: Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Keywords: Glasgow Coma Scale, severe traumatic brain injury, prehospital intubation, hypotension, hypoxia, periorbital swelling, inter-center variability, injury severity assessment
MeSH terms: Clinical Protocols, Data Collection, Emergency Medical Services, Emergency Service, Hospital, Craniocerebral Trauma, Humans, Neurosurgery, Patient Admission, Personnel, Hospital, Practice Patterns, Physicians', Surveys and Questionnaires, Time Factors, Trauma Centers, Traumatology, United States, Reproducibility of Results, Glasgow Coma Scale, Confounding Factors, Epidemiologic, Practice Guidelines as Topic

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PROBLEMS WITH INITIAL GLASGOW COMA SCALE ASSESSMENT CAUSED BY PREHOSPITAL TREATMENT OF PATIENTS WITH HEAD INJURIES: RESULTS OF A NATIONAL SURVEY

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