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[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or
M M Sánchez-Sánchez1, R Sánchez-Izquierdo1, E I Sánchez-Muñoz1
1Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España.
Introduction:
The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response.
Objective:
To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components.
Methods:
Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails.
Results:
The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991).
Conclusion:
In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.
