title: Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients.
abstract: Trauma victims are frequently triaged to a trauma center according to the patient's calculated Glasgow Coma Scale (GCS) score despite its known inconsistencies. The substitution of a simpler binary assessment of GCS-motor (GCS-m) score less than 6 (ie, "patient does not follow commands") would simplify field triage. We compare total GCS score to this binary assessment for predicting trauma outcomes.
  
  
  
  This retrospective analysis of a statewide trauma registry includes records from 393,877 patients from 1999 to 2013. Patients with initial GCS score less than or equal to 13 were compared with those with GCS-m score less than 6 for outcomes of Injury Severity Score (ISS) greater than 15, ISS greater than 24, death, ICU admission, need for surgery, or need for craniotomy. We judged a priori that differences less than 5% lack clinical importance.
  
  
  
  The relative differences between GCS and GCS-m scores less than 6 were less than 5% and thus clinically unimportant for all outcomes tested, even when statistically significant. For the 6 outcomes, the differences in areas under receiver operating characteristic curves ranged from 0.014 to 0.048. Total GCS score less than or equal to 13 was slightly more sensitive (difference 3.3%; 95% confidence interval 3.2% to 3.4%) and slightly less specific (difference -1.5%; 95% confidence interval -1.6% to -1.5%) than GCS-m score less than 6 for predicting ISS greater than 15, with similar overall accuracy (74.1% versus 74.2%).
  
  
  
  Replacement of the total GCS score with a simple binary decision point of GCS-m score less than 6, or a patient who "does not follow commands," predicts serious injury, as well as the total GCS score, and would simplify out-of-hospital trauma triage.
authors.affiliation: Department of Emergency Medicine, Geisinger Health System, Danville, PA. Electronic address: dkupas@geisinger.edu.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Kupas
authors.affiliation: Department of Emergency Medicine, Geisinger Health System, Danville, PA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Melnychuk
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, PA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Young
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011597:Psychomotor Performance; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis*