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

Published online by Cambridge University Press:  28 June 2012

Amado Alejandro Báez ,
Ediza M. Giráldez  and
Julio M. De Peña
Amado Alejandro Báez*
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic
Ediza M. Giráldez
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic
Julio M. De Peña
Affiliation:
Research Committee, Dominican Society of Prehospital Medicine, Santo Domingo, Dominican Republic Department of Emergency Medicine, University of Puerto Rico, San Juan, Puerto Rico
*
Amado Alejandro Báez Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115USA Email: aabaez@partners.org
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Abstract

Introduction:

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.

Methods:

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.

Results:

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.

Conclusions:

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

Keywords

Emergency Medical ServicesGlasgow Coma ScaleinjuryLatin Americaprehospitaltrauma
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 3 , June 2007 , pp. 230 - 232
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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