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Precision and Reliability of the Glasgow Coma Scale Score among a Cohort of Latin American Prehospital Emergency Care Providers

  • Amado Alejandro Báez (a1) (a2), Ediza M. Giráldez (a1) (a2) and Julio M. De Peña (a2) (a3)



The Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness in patients with head injuries.Rapid and accurate GCS scoring is essential for adequate assessment and treatment of critically sick and injured patients. This study sought out to determine the precision and reliability of the GCS among a cohort of Latin American Critical Care Transport Providers.


The study consisted of a cross-sectional design using an Internetbased examination. The evaluation consisted of four focused clinical scenarios with a classification based on severity. For measurement of intra-rater reliability the first and fourth cases were identical. Five minutes were allocated for each scenario. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations. For all tests, statistical significance was set at the 0.05 level.


A total of 62 providers participated, including 17 physicians and 45 advanced providers (nurses and paramedics). No statistically significant differences were observed between physicians and advanced providers in the correct classification of the individual scenarios. Five of the 17 physicians (29.4%) answered all cases correctly, while none of the 45 advanced providers did (p <0.001). When evaluating the duplicated cases (Cases 1 and 4), five physicians (29.4%) and 11 advanced providers (24.4%) correctly classified the cases. This difference was not statistically significant.


This study demonstrated a poor precision and poor reliability in the use of the Glasgow Coma Scale within the study subjects.


Corresponding author

Amado Alejandro Báez Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115USA Email:


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1.Teasdale, G, Jennett, B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:8184.
2.Teasdale, G, Jennett, B: Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 1976;34(1–4):4555.
3.American College of Surgeons (ACS) Committee on Trauma: Resources for the Optimal Care of the Injured Patient: 1999. Chicago: American College of Surgeons, 1998.
4.Champion, HR, Sacco, WJ, Carnazzo, AJ, Copes, W, Fouty, WJ:Trauma score. Crit Care Med 1981;9(9):672676.
5.Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME: A revision of the Trauma Score. J Trauma 1989;29(5):623629.
6.Chesnut, RM: The management of severe traumatic brain injury. Emerg Med Clin Am 1997;15(3):581604.
7.Gormican, SP: CRAMS scale: Field triage of trauma victims. Ann Emerg Med 1982;11(3):132135.
8.Boyd, CR, Tolson, MA, Copes, WS: Evaluating trauma care:The TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987;27(4):370378.
9.Knaus, WA, Zimmerman, JE, Wagner, DP, Draper, EA, Lawrence, DE: APACHE-acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981;9(8):591597.
10.Jennett, B, Teasdale, G, Braakman, R, Minderhoud, J, Knill-Jones, R: Predicting outcome in individual patients after severe head injury. Lancet 1976;1(7968): 10311034.
11.Bastos, PG, Sun, X, Wagner, DP, Wu, AW, Knaus, WA: Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: Findings from the acute physiology and chronic health evaluation III study. Crit Care Med 1993;21(10):14591465.
12.White, JR, Farukhi, Z, Bull, C, Christensen, J, Gordon, T, Paidas, C, Nichols, DG: Predictors of outcome in severely head-injured children. Crit Care Med 2001;29(3):534540.
13.Winkler, JV, Rosen, P, Alfry, EJ: Prehospital use of the Glasgow Coma Scale in severe head injury. J Emerg Med 1984;2(1):16.
14.Crossman, J, Bankes, M, Bhan, A, Crockard HA: The Glasgow Coma Score: Reliable evidence? Injury 1998;29(6):435437.
15.Menegazzi, JJ, Davis, EA, Sucov, AN, Paris, PM: Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma 1993;34(1):4648.
16.Rowley, G, Fielding, K: Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet 1991;337(8740):535538.
17.Lane, PL, Baez, AA, Brabson, T, Burmeister, DD, Kelly, JJ: Effectiveness of a Glasgow Coma Scale instructional video for EMS providers. Prehosp Disast Med 2002;17(3):142146.


Precision and Reliability of the Glasgow Coma Scale Score among a Cohort of Latin American Prehospital Emergency Care Providers

  • Amado Alejandro Báez (a1) (a2), Ediza M. Giráldez (a1) (a2) and Julio M. De Peña (a2) (a3)


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