title: Predictive Utility of the Total Glasgow Coma Scale Versus the Motor Component of the Glasgow Coma Scale for Identification of Patients With Serious Traumatic Injuries.
abstract: OBJECTIVE
  The motor component of the Glasgow Coma Scale (mGCS) has been proposed as an easier-to-use alternative to the total GCS (tGCS) for field assessment of trauma patients by emergency medical services. We perform a systematic review and meta-analysis to compare the predictive utility of the tGCS versus the mGCS or Simplified Motor Scale in field triage of trauma for identifying patients with adverse outcomes (inhospital mortality or severe brain injury) or who underwent procedures (neurosurgical intervention or emergency intubation) indicating need for high-level trauma care.
  
  
  METHODS
  Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Health and Psychosocial Instruments, and the Cochrane databases were searched through June 2016 for English-language cohort studies. We included studies that compared the area under the receiver operating characteristic curve (AUROC) of the tGCS versus the mGCS or Simplified Motor Scale assessed in the field or shortly after arrival in the emergency department for predicting the outcomes described above. Meta-analyses were performed with a random-effects model, and subgroup and sensitivity analyses were conducted.
  
  
  RESULTS
  We included 18 head-to-head studies of predictive utility (n=1,703,388). For inhospital mortality, the tGCS was associated with slightly greater discrimination than the mGCS (pooled mean difference in [AUROC] 0.015; 95% confidence interval [CI] 0.009 to 0.022; I2=85%; 12 studies) or the Simplified Motor Scale (pooled mean difference in AUROC 0.030; 95% CI 0.024 to 0.036; I2=0%; 5 studies). The tGCS was also associated with greater discrimination than the mGCS or Simplified Motor Scale for nonmortality outcomes (differences in AUROC from 0.03 to 0.05). Findings were robust in subgroup and sensitivity analyses.
  
  
  CONCLUSIONS
  The tGCS is associated with slightly greater discrimination than the mGCS or Simplified Motor Scale for identifying severe trauma. The small differences in discrimination are likely to be clinically unimportant and could be offset by factors such as convenience and ease of use.
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; Department of Medicine, Oregon Health & Science University, Portland, OR. Electronic address: chour@ohsu.edu.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Totten
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Nancy
authors.initials: N
authors.lastname: Carney
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Spencer
authors.initials: S
authors.lastname: Dandy
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University, Portland, OR.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Sara
authors.initials: S
authors.lastname: Grusing
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.affiliation: Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Ngoc
authors.initials: N
authors.lastname: Wasson
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
mesh_terms: D004632:Emergency Medical Services / Q000379:methods; D015600:Glasgow Coma Scale / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012372:ROC Curve; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000503:physiopathology