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Randomized controlled trial of a scoring aid to improve Glasgow Coma Scale scoring by emergency medical services
Amanda Feldman1, Kimberly W Hart2, Christopher J Lindsell2
1Northeast Ohio Medical University, Akron, OH.
Study Objective:
Emergency medical services (EMS) personnel frequently use the Glasgow Coma Scale (GCS) to assess injured and critically ill patients. This study assesses the accuracy of EMS providers' GCS scoring, as well as the improvement in GCS score assessment with the use of a scoring aid.
Methods:
This randomized, controlled study was conducted in the emergency department (ED) of an urban academic trauma center. Emergency medical technicians or paramedics who transported a patient to the ED were randomly assigned one of 9 written scenarios, either with or without a GCS scoring aid. Scenarios were created by consensus of expert attending emergency medicine, EMS, and neurocritical care physicians, with universal consensus agreement on GCS scores. χ(2) And Student's t tests were used to compare groups.
Results:
Of 180 participants, 178 completed the study. Overall, 73 of 178 participants (41%) gave a GCS score that matched the expert consensus score. GCS score was correct in 22 of 88 (25%) cases without the scoring aid. GCS was correct in 51 of 90 (57%) cases with the scoring aid. Most (69%) of the total GCS scores fell within 1 point of the expert consensus GCS score. Differences in accuracy were most pronounced in scenarios with a correct GCS score of 12 or below. Subcomponent accuracy was eye 62%, verbal 70%, and motor 51%.
Conclusion:
In this study, 60% of EMS participants provided inaccurate GCS score estimates. Use of a GCS scoring aid improved accuracy of EMS GCS score assessments.
