title: Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians.
abstract: OBJECTIVE
  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)".
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo 160-8582, Japan. namiki@sc.itc.keio.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Namiki
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Funabiki
authors.forename: Shingo
authors.initials: S
authors.lastname: Hori
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis; D002983:Clinical Competence; D003128:Coma / Q000175:diagnosis*; D003198:Computer Simulation; D003244:Consciousness Disorders / Q000175:diagnosis; D003627:Data Interpretation, Statistical; D003951:Diagnostic Errors; D004493:Education; D004635:Emergency Medicine / Q000193:education; D015600:Glasgow Coma Scale / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D014741:Video Recording