The relationship between pre-hospital and emergency department Glasgow coma scale scores
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Jeffrey J Bazarian1, Melissa A Eirich, Steven D Salhanick
1Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. jeff_bazarian@urmc.rochester.edu
Introduction:
Pre-hospital GCS scores are used to make critical patient care decisions and to fill in gaps in hospital-based TBI surveillance, but they may not be accurate.
Objective:
To determine the relationship between pre-hospital (EMS-GCS) and emergency physician GCS scores (ED-GCS).
Methods:
Prospective observational study of 60 TBI patients with a field GCS of 8-13 and age > 18. ED-GCS, EMS-GCS, time of GCS and vitals signs were recorded.
Analysis:
Simple and multiple linear regression.
Results:
The median EMS-GCS was 13 and that for ED-GCS was 15. There was a significant linear relationship between ED-GCS and EMS-GCS (r = 0.45, p = 0.003). There was improvement in the prediction of ED-GCS when alcohol/drug use and age (but not time) were added to EMS-GCS.
Conclusion:
EMS-GCS is usually two points lower than ED-GCS, but the correlation between them is strong and independent of the time between score determinations. These results could prevent unnecessary procedures based on the EMS-GCS and improve the accuracy of TBI surveillance.
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