TY - JOUR
T1 - Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians
AU - Namiki, Jun
AU - Yamazaki, Motoyasu
AU - Funabiki, Tomohiro
AU - Hori, Shingo
N1 - Funding Information:
The authors thank Mr. Kiyotaka Yasui, Department of Medical Education Center, Keio University School of Medicine, and the medical students at Keio University who are members of the Keio ACLS Popularizing and Promoting Association, for the production of the video simulation. This work was partly supported by the General Insurance Association of Japan .
PY - 2011/6
Y1 - 2011/6
N2 - Objectives: Appropriate triage of a large number of patients with head injury is crucial in the emergency department (ED) as well as in the field. Traumatic brain injury (TBI) is primarily assessed using the Glasgow Coma Scale (GCS) to evaluate consciousness. However, GCS score assignment is far from sufficiently reliable for correct assessment, especially with inexperienced users. The purpose of this study was to reveal what factors are misjudged when assessed by inexperienced medical personnel. Methods: We analyzed GCS eye, verbal, and motor response (EVM) scoring profiles conducted by postgraduate year 1 junior residents (n = 94) before they began residency in specific departments. GCS assessment was tested using a video simulation that portrayed mock patients with eight different levels of consciousness that are frequently encountered in trauma patients. Results: On average, 26 ± 18% of examinees failed to provide the correct EVM profiles for the eight selected consciousness levels. Primary misjudged GCS factors belonged to two categories: the assessment of "confused conversation (V4)", and the assessment of "withdrawal motor response (M4)". Conclusion: Additional instruction regarding the specific misjudged factors identified in this study may help inexperienced medical personnel improve the reliability of GCS score assignment to casualties with TBI.
AB - Objectives: Appropriate triage of a large number of patients with head injury is crucial in the emergency department (ED) as well as in the field. Traumatic brain injury (TBI) is primarily assessed using the Glasgow Coma Scale (GCS) to evaluate consciousness. However, GCS score assignment is far from sufficiently reliable for correct assessment, especially with inexperienced users. The purpose of this study was to reveal what factors are misjudged when assessed by inexperienced medical personnel. Methods: We analyzed GCS eye, verbal, and motor response (EVM) scoring profiles conducted by postgraduate year 1 junior residents (n = 94) before they began residency in specific departments. GCS assessment was tested using a video simulation that portrayed mock patients with eight different levels of consciousness that are frequently encountered in trauma patients. Results: On average, 26 ± 18% of examinees failed to provide the correct EVM profiles for the eight selected consciousness levels. Primary misjudged GCS factors belonged to two categories: the assessment of "confused conversation (V4)", and the assessment of "withdrawal motor response (M4)". Conclusion: Additional instruction regarding the specific misjudged factors identified in this study may help inexperienced medical personnel improve the reliability of GCS score assignment to casualties with TBI.
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U2 - 10.1016/j.clineuro.2011.01.001
DO - 10.1016/j.clineuro.2011.01.001
M3 - Article
C2 - 21295908
AN - SCOPUS:79955836958
SN - 0303-8467
VL - 113
SP - 393
EP - 398
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
IS - 5
ER -