トリアージおよび蘇生看護師間における標準化トレーニング後のグラスゴー・コーマ・スケール（GCS）の評価者間信頼性
Yangchun Zhang1, Cairong Liu1, Feng Chen1
1Emergency Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China, njmu.edu.cn.
Aims:
To evaluate Glasgow Coma Scale (GCS) inter-rater reliability between triage and resuscitation nurses following standardized training and identify factors influencing scoring consistency in a high-volume Chinese trauma center.
Design:
A prospective observational study adhering to STROBE guidelines.
Methods:
Data were collected from 875 trauma patients and 71 nurses (30 triage and 41 resuscitation) between April and December 2024. Nurses completed a 19-h standardized GCS training program. Patients underwent two independent GCS assessments within ≤ 5 min: first by triage nurses and then by resuscitation nurses. Inter-rater reliability was assessed using percentage agreement, weighted Cohen's kappa, intraclass correlation coefficients (ICC), and correlation analyses. Multivariate logistic regression identified factors associated with scoring consistency.
Results:
GCS components and total scores demonstrated high inter-rater reliability (weighted kappa: 0.85-0.96; ICC: 0.85-0.96). Perfect agreement occurred in 65.3% of total GCS scores, with 89.8% differing by ≤ 1 point. Verbal response showed the highest component agreement (87.1%), followed by eye opening (86.5%) and motor response (75.1%). Patient characteristics significantly influenced consistency, with traumatic brain injury (adjusted OR = 0.22, p < 0.001) and injury severity scores ≥ 16 (adjusted OR = 0.34, p < 0.001) associated with reduced agreement. Nurses' experience, education, and professional rank did not significantly affect reliability.
Conclusion:
Poststandardized training, GCS assessments showed high inter-rater reliability among emergency nurses, though motor response demonstrated comparatively lower consistency. Injury severity and traumatic brain injury were primary factors affecting scoring agreement, indicating the need for heightened vigilance when assessing critically ill patients.
Relevance To Clinical Practice:
Within China's developing prehospital triage infrastructure, standardized GCS training can substantially improve neurological assessment reliability in emergency settings, facilitating accurate identification of critically injured patients and optimizing resource allocation.
Patient Or Public Contribution:
No patient or public contribution.
