A Comparison of the Prehospital Motor Component of the Glasgow Coma Scale (mGCS) to the Prehospital Total GCS (tGCS) as a Prehospital Risk Adjustment Measure for Trauma Patients

Beskind, Daniel; Stolz, Uwe; Gross, Austin; Earp, Ryan; Mitchelson, Justin; Judkins, Daniel; Bowlby, Paul; Guillen-Rodriguez, José

doi:10.3109/10903127.2013.844870

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…Previous studies have shown that the GCS-M could accurately assess the prognosis in TBI and cardiac arrest patients. [ 10 11 ] Our results showed that the GCS-M was a predictor of death or unfavorable outcome in intubated acute severe cerebral vascular disease patients (AUC 0.730 and 0.827), while its prognostic power was equivalent to that of the GCS. This was consistent with the Handschu et al .,[ 12 ] study (90 patients), in which the GCS-M had similar prognostic strength to the GCS in predicting morality in intubated acute severe cerebral vascular disease patients, though the AUCs were smaller than ours (GCS: 0.69 and GCS-M: 0.64).…”

Section: Discussionmentioning

confidence: 72%

Study of Simplified Coma Scales

Wang

Liu

et al. 2018

Chinese Medical Journal

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Background:Whether the Glasgow Coma Scale (GCS) can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component (GCS-M)/Simplified Motor Score (SMS) to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients.Methods:A retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit (NCU). Outcomes were death and unfavorable prognosis (modified Rankin Scale: 5–6) at NCU discharge. The receiver operating characteristic (ROC) curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves (AUCs) was performed using the Z-test.Results:Of 106 patients included in the study, 41 (38.7%) patients died, and 69 (65.1%) patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale's predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h (0.721 vs. 0.717, Z = 0.135, P = 0.893) and 72 h (0.730 vs. 0.765, Z = 1.887, P = 0.060), in predicting poor prognosis at 0 h (0.827 vs. 0.819, Z = 0.395, P = 0.693), 24 h (0.771 vs. 0.760, Z = 0.944, P = 0.345), 48 h (0.732 vs. 0.741, Z = 0.593, P = 0.590), and 72 h (0.775 vs. 0.780, Z = 0.302, P = 0.763). AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death (0.964 vs. 0.964, P = 1.000) and poor prognosis (1.000 vs. 1.000, P = 1.000) for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M (<0.700), in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). The SMS AUCs (<0.700) in predicting outcomes were poor.Conclusions:The GCS-M approaches the same test performance as the GCS in assessing the prognosis of intubated acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.

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Section: Discussionmentioning

confidence: 72%

Study of Simplified Coma Scales

Wang

Liu

et al. 2018

Chinese Medical Journal

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“…A second study also focused on the pre-hospital emergency care of trauma patients, comparing mGCS with GCS total . 31 Outcomes examined included the need for intubation, survival to hospital FIG. 2.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that mGCS was equivalent to GCS total because the differences in the C-statistic were so minimal that they did not translate to a clinically meaningful difference in predicting intubation or survival. 31 Our study has important limitations. Our results are only applicable to intubated moderate to severe TBI patients.…”

Section: Verbal Gcs Subscore In Intubated Tbi Patientsmentioning

confidence: 90%

The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better?

Cheng

Bassil

Carandang

et al. 2017

Journal of Neurotrauma

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The Glasgow Coma Scale (GCS) has limited utility in intubated patients due to the inability to assign verbal subscores. The verbal subscore can be derived from the eye and motor subscores using a mathematical model, but the advantage of this method and its use in outcome prognostication in traumatic brain injury (TBI) patients remains unknown. We compared the validated "Core+CT"-IMPACT-model performance in 251 intubated TBI patients prospectively enrolled in the longitudinal OPTIMISM study between November 2009 and May 2015 when substituting the original motor GCS (mGCS) with the total estimated GCS (teGCS; with estimated verbal subscore). We hypothesized that model performance would improve with teGCS. Glasgow Outcome Scale (GOS) scores were assessed at 3 and 12 months by trained interviewers. In the complete case analysis, there was no statistically or clinically significant difference in the discrimination (C-statistic) at either time-point using the mGCS versus the teGCS (3 months: 0.893 vs. 0.871;12 months: 0.926 vs. 0.92). At 3 months, IMPACT-model calibration was excellent with mGCS and teGCS (Hosmer-Lemeshow "goodness-of-fit" chi square p value 0.9293 and 0.9934, respectively); it was adequate at 12 months with teGCS (0.5893) but low with mGCS (0.0158), possibly related to diminished power at 12 months. At both time-points, motor GCS contributed more to the variability of outcome (Nagelkerke ΔR) than teGCS (3 months: 5.8% vs. 0.4%; 12 months: 5% vs. 2.6%). The sensitivity analysis with imputed missing outcomes yielded similar results, with improved calibration for both GCS variants. In our cohort of intubated TBI patients, there was no statistically or clinically meaningful improvement in the IMPACT-model performance by substituting the original mGCS with teGCS.

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“…Our data thus confirm the findings of previous studies that our simpler decision point is just as predictive of trauma outcomes as the full GCS. 13,14 A simplified field triage score for battlefield casualties, which includes the GCS-m, has shown promising results for use as a practical instrument in the combat zone. 15 Additionally, the use of motor response in children after they sustain a traumatic head injury has shown to predict long-term outcome, as well as the full GCS score, with better interobserver agreement.…”

Section: Discussionmentioning

confidence: 99%

Glasgow Coma Scale Motor Component (“Patient Does Not Follow Commands”) Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients

Kupas

Melnychuk

Young

2016

Annals of Emergency Medicine

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A Comparison of the Prehospital Motor Component of the Glasgow Coma Scale (mGCS) to the Prehospital Total GCS (tGCS) as a Prehospital Risk Adjustment Measure for Trauma Patients

Abstract: The prehospital mGCS appears have good discriminatory power and is equivalent to the prehospital tGCS for predicting intubation and survival to hospital discharge in this trauma population as a whole, those with ISS ≥ 16, or TBI.

Cited by 19 publications

References 23 publications

Study of Simplified Coma Scales

Study of Simplified Coma Scales

The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better?

Glasgow Coma Scale Motor Component (“Patient Does Not Follow Commands”) Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients

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