title: Glasgow Coma Scale Scoring is Often Inaccurate.
abstract: BACKGROUND
  The Glasgow Coma Scale (GCS) is widely applied in the emergency setting; it is used to guide trauma triage and for the application of essential interventions such as endotracheal intubation. However, inter-rater reliability of GCS scoring has been shown to be low for inexperienced users, especially for the motor component. Concerns regarding the accuracy and validity of GCS scoring between various types of emergency care providers have been expressed. Hypothesis/Problem The objective of this study was to determine the degree of accuracy of GCS scoring between various emergency care providers within a modern Emergency Medical Services (EMS) system.
  
  
  METHODS
  This was a prospective observational study of the accuracy of GCS scoring using a convenience sample of various types of emergency medical providers using standardized video vignettes. Ten video vignettes using adults were prepared and scored by two board-certified neurologists. Inter-rater reliability was excellent (Cohen's κ = 1). Subjects viewed the video and then scored each scenario. The scoring of subjects was compared to expert scoring of the two board-certified neurologists.
  
  
  RESULTS
  A total of 217 emergency providers watched 10 video vignettes and provided 2,084 observations of GCS scoring. Overall total GCS scoring accuracy was 33.1% (95% CI, 30.2-36.0). The highest accuracy was observed on the verbal component of the GCS (69.2%; 95% CI, 67.8-70.4). The eye-opening component was the second most accurate (61.2%; 95% CI, 59.5-62.9). The least accurate component was the motor component (59.8%; 95% CI, 58.1-61.5). A small number of subjects (9.2%) assigned GCS scores that do not exist in the GCS scoring system.
  
  
  CONCLUSIONS
  Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Bledsoe
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Casey
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Jay
authors.initials: J
authors.lastname: Feldman
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Larry
authors.initials: L
authors.lastname: Johnson
authors.affiliation: 2MedicWest Ambulance/American Medical Response,Las Vegas,NevadaUSA.
authors.forename: Scott
authors.initials: S
authors.lastname: Diel
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Wes
authors.initials: W
authors.lastname: Forred
authors.affiliation: 1Department of Emergency Medicine and Department of Trauma Surgery,University of Nevada School of Medicine,Las Vegas,NevadaUSA.
authors.forename: Codee
authors.initials: C
authors.lastname: Gorman
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D014741:Video Recording
keywords: EMS Emergency Medical Services; GCS Glasgow Coma Scale; SMS Simplified Motor Scale; SVS Simplified Verbal Scale; TBI traumatic brain injury; trauma care