Interrater Reliability of 3 Simplified Neurologic Scales Applied to Adults Presenting to the Emergency Department With Altered Levels of Consciousness

Gill, Michelle; Martens, Kevin; Lynch, Elizabeth; Salih, Ahmad Ali; Green, Steven M.

doi:10.1016/j.annemergmed.2006.03.031

Cited by 94 publications

(81 citation statements)

References 12 publications

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“…Altered mental status, specifically as assessed by the GCS and other rating scales, has been most extensively studied, although much of the published work is in adult patients, 16,17 or in patients with conditions other than acute head injury. 18,19 In a study of children with minor head injury (defined as at nine Canadian pediatric teaching hospitals, Osmond et al 20 found moderate agreement in initial GCS, with j = 0.54. Holmes et al, 21 studying children with head injury of any severity at a single ED, found excellent agreement on GCS, with weighted j = 0.77 among patients 2 years of age and younger, and j = 0.91 for older children.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Gorelick

Atabaki

Hoyle

et al. 2008

Academic Emergency Medicine

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Objectives: To be useful in development of clinical decision rules, clinical variables must demonstrate acceptable agreement when assessed by different observers. The objective was to determine the interobserver agreement in the assessment of historical and physical examination findings of children undergoing emergency department (ED) evaluation for blunt head trauma.Methods: This was a prospective cohort study of children younger than 18 years evaluated for blunt head trauma at one of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Patients were excluded if injury occurred more than 24 hours prior to evaluation, if neuroimaging was obtained at another hospital prior to evaluation, or if the patient had a clinically trivial mechanism of injury. Two clinicians independently completed a standardized clinical assessment on a templated data form. Assessments were performed within 60 minutes of each other and prior to clinician review of any neuroimaging (if obtained). Agreement between the two observers beyond that expected by chance was calculated for each clinical variable, using the kappa (j) statistic for categorical variables and weighted kappa for ordinal variables. Variables with a lower 95% confidence limit (LCL) of j > 0.4 were considered to have acceptable agreement.Results: Fifteen-hundred pairs of observations were obtained. Acceptable agreement was achieved in 27 of the 32 variables studied (84%). Mechanism of injury (low, medium, or high risk) had j = 0.83. For subjective symptoms, kappa ranged from 0.47 (dizziness) to 0.93 (frequency of vomiting); all had 95% LCL > 0.4. Of the physical examination findings, kappa ranged from 0.22 (agitated) to 0.89 (Glasgow Coma Scale [GCS] score). The 95% LCL for kappa was <0.4 for four individual signs of altered mental status and for quality (i.e., boggy or firm) of scalp hematoma if present.Conclusions: Both subjective and objective clinical variables in children with blunt head trauma can be assessed by different observers with acceptable agreement, making these variables suitable candidates for clinical decision rules.

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Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Gorelick

Atabaki

Hoyle

et al. 2008

Academic Emergency Medicine

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“…The present study confirms previous reports on a less than perfect interobserver agreement of the GCS. [10][11][12] For the new FOUR score, the interrater agreement was never worse and partly better than that of the GCS. But in our study there were no significantly difference between interrater agreements.…”

Section: Figure 2: Results Of Gcs Scoresmentioning

confidence: 99%

Yoğun Bakım Ünitelerinde Nörolojik Durumun Değerlendirilmesinde Kullanılan GKS ve FOUR Skorlarının Karşılaştırılması

Şahin¹,

Şahin²,

Öztürk³

et al. 2015

J Contemp Med

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ÖZET Amaç: Yoğun bakım hastalarında nörolojik durumun değerlendirilmesinde en yaygın olarak kullanılan ölçek Glasgow Koma Skalası'dır (GKS). GKS'deki sınırlamalar entübe veya afazik hastalardaki verbal yanıt zorluğunu içermektedir. Full Outline of UnResponsiveness (FOUR) skoru son zamanlarda önerilen sözlü yanıta bağımlı olmayan yeni bir koma skalasıdır. Yeni skalalar, ileri nörolojik ayrıntıyı kolayca sağlayabilen bir skalayı kuvvetle önermektedir. Bizim çalışmamızın amacı FOUR skorun GKS ile yoğun bakımda yatan tüm hastalarda karşılaştırılması ve gözlemciler arası güvenirliğinin saptanmasıdır.Gereç ve Yöntemler: Çalışmamıza 105 hasta dahil edildi. Hastalar üç farklı uygulayıcı (yoğun bakım hemşiresi, 2.yıl anestezi asistanı, anestezi uzmanı) tarafından FOUR ve GKS skorları açısından değerlendirildi. Sedasyon veya kas gevşetici alan hastalar çalışma dışı bırakıldı. Her hasta, üç uygulayıcı tarafından, birbirinin değerlendirmelerinden habersiz ve en fazla bir saat aralıklı olacak şekilde değerlendirildi.Bulgular: Çalışmamızda GKS ve FOUR Skorları, uygulayıcılar arasındaki uyumluluk bakımından karşılaştırılmaktadır. FOUR skorunun entübe ve afazik hastalarda üstün olabileceği düşünülse de istatistiksel olarak ne GKS ve FOUR Skorları ne de uygulayıcılar arasında anlamlı fark saptanmadı.Sonuç: Sonuç olarak, yoğun bakımlarda kullanılan skorlar basit, güvenilir ve öngörülebilir olmalıdır. Bizim çalışmamız göstermiştir ki, FOUR skor en az GKS kadar güvenilirdir. Ayrıca GKS ve FOUR skorlarının hem doktorlar hem de hemşireler için kullanımı kolaydır.Anahtar Kelimeler: Full Outline of Unresponsiveness Score, Glasgow Koma Skalası, yoğun bakım ünitesi ABSTRACT Objective: The Glasgow Coma Scale (GCS) is the most widely used scoring system to evaluation of neurological status for patients in intensive care unit. Limitations of the GCS include severe to assess the verbal score in intubated or aphasic patients. The Full Outline of UnResponsiveness score (FOUR), a new coma scale not reliant on verbal response, was recently proposed. New scales strongly suggest a scale is needed that could provide further nerological detail that is easy to use. We aimed to compare FOUR score and GCS among unselected patients in intensive care units and comparerealibility betweenobservers.Material-Methods: In our study 105 patients was admitted. Three different types of examiners tested FOUR score and GCS: one intensive care unit nurse, one anaesthesiology resident (2. year), and one anaesthesiology fellow. Patients receiving sedative agents or neuromuscular function blockers were excluded. The raters performed their examination within 1 hour of each other without knowledge of the others scores.Results: In our study compared the interrater agreement of GCS and FOUR score. Although FOUR score was thought to be superior in aphasic and intubated patients, there was neither a statistical significant difference between the GCS and the FOUR score nor a difference among ICU staff.Conclusion: As a result, the scores that used in ICUs, should be simple, re...

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“…9,29 If the variables are presented as dichotomous choices, e.g. ability to localize a painful stimulus, 9 then the findings are more likely to be reliable.…”

Section: Scales For Neonates and Infantsmentioning

confidence: 99%

“…mands, 1: localizes pain, 0: withdrawal to pain or less) showed the least interobserver variability compared with both four-point scales and the GCS, as well as being a good predictor of outcome after trauma in adults. 29 However, although useful in the emergency setting, such a simplification is unlikely to cover all eventualities in the longer-term management of patients with complex problems. No other scale has taken the place of the GCS either in clinical practice or for research and this methodology is still recommended for more precise assessment and monitoring of children with an impaired level of consciousness, 28 although there has been no consensus on the most appropriate modifications for the paediatric age range.…”

Section: 3mentioning

confidence: 99%

“…28 However, the few interobserver data available suggest that this scale performs worse than the GCS 29 (Table III) and it is not as sensitive as the motor component of the GCS at predicting death in children with blunt trauma. 30 The alert, confused, drowsy, unresponsive (ACDU) scale appears no better 29 …”

Section: Requirements For An Ideal Coma Scale and Problems In Achievimentioning

confidence: 99%

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Paediatric coma scales

Kirkham

Newton

Whitehouse

2008

Develop Med Child Neuro

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Traumatic and non-traumatic coma is a common problem in paediatric practice with high mortality and morbidity. Early recognition of the potential for catastrophic deterioration in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children. Prediction of outcome is probably less important, as this may be able to be modified by appropriate emergency treatment, and other clinical and neurophysiological criteria allow a greater degree of precision. The scales should be reliable, i.e. with little variation between observers and in test-retest by one observer, since this promotes confidence in the assessments at different time points and by different examiners. This is particularly important when the patient is being assessed by personnel dealing with adults as well as children, discussed on the telephone, handed over at shift change, or transferred between units or hospitals. The British Paediatric Neurology Association has recommended one of the modified child's Glasgow coma scales (CGCS) for use in the UK. This review looks at the recent history of the development of coma scales and the rationale for recommending the CGCS.Traumatic and non-traumatic coma is a common problem in paediatric practice with high mortality and morbidity. 1 Early recognition in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children. The British Paediatric Neurology Association has recommended one of the modified paediatric Glasgow coma scales (GCS) originally developed by James and Trauner 2 (child's Glasgow coma scale [CGCS]; Tables I, II, and III) for use in the UK. This review looks at the recent history of the development of coma scales and the rationale for recommending the CGCS. Requirements for an ideal coma scale and problems in achieving thisThe criteria for an ideal coma scale are that it should be easily administered, useful in a wide range of ages and clinical conditions, consistent between observers (Table III), and sufficiently discriminating to identify levels of coma requiring specific interventions. Many scales have also been used in attempts to predict outcome, 3-5 although this may be a less realistic goal since the advent of intensive care in the developed world, as sedation and paralysis interfere with the accurate assessment of depth of coma at the time points that are discriminatory, and interventions may alter outcome. None of the clinical scales are sufficiently sensitive or specific enough for it to be justifiable to wake up a patient, sedated and/or paralysed for optimal intensive care, to perform them, especially as additional clinical information 6 and alternative neurophysiological techniques have better predictive power 7 for death and poor neurological outcome respectively. However, GCS at injury or on admission is associated with outcome and was the most important...

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Interrater Reliability of 3 Simplified Neurologic Scales Applied to Adults Presenting to the Emergency Department With Altered Levels of Consciousness

Cited by 94 publications

References 12 publications

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Yoğun Bakım Ünitelerinde Nörolojik Durumun Değerlendirilmesinde Kullanılan GKS ve FOUR Skorlarının Karşılaştırılması

Paediatric coma scales

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