Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes After Traumatic Brain Injury

Thompson, David; Hurtado, Timothy R.; Liao, Michael M.; Byyny, Richard L.; Gravitz, Craig; Haukoos, Jason S.

doi:10.1016/j.annemergmed.2011.05.033

Cited by 50 publications

(29 citation statements)

References 20 publications

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“…Additionally, many of the papers that compare GCS to a newer tool of mental status assessment rely on retrospectively recorded prehospital GCS values as the criterion standard. 18,19 Our results do not support abandoning the full GCS in favor of these alternatives.…”

Section: Discussioncontrasting

confidence: 65%

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Randomized Controlled Trial of a Scoring Aid to Improve Glasgow Coma Scale Scoring by Emergency Medical Services Providers

Feldman

Hart

Lindsell

et al. 2015

Annals of Emergency Medicine

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Objective Emergency medical services (EMS) personnel frequently use the Glasgow Coma Scale (GCS) to assess injured and critically ill patients. This study assessed the accuracy of EMS providers’ GCS scoring as well as the improvement in GCS assessment with the use of a scoring aid. Methods This randomized, controlled study was conducted in the emergency department (ED) of an urban, academic trauma center. Emergency medical technicians or paramedics who transported a patient to the ED were randomly assessed one of nine written scenarios, either with or without a GCS scoring aid. Scenarios were created by consensus of expert attending emergency medicine, EMS, and neurocritical care physicians with universal consensus agreement on GCS scores. Chi-square and student’s t-tests were used to compare groups. Results Of 180 participants, 178 completed the study. Overall, 73/178 (41%) participants gave a GCS score that matched the expert consensus score. GCS was correct in 22/88 (25%) of cases without the scoring aid. GCS was correct in 51/90 (57%) of cases with the scoring aid. Most (69%) of total GCS scores fell within one point of the expert consensus GCS score. Differences in accuracy were most pronounced in scenarios with a correct GCS of 12 or below. Sub-component accuracy was: eye 62%, verbal 70%, and motor 51%. Conclusion In this study, 60% of EMS participants provided inaccurate GCS estimates. Use of a GCS scoring aid improved accuracy of EMS GCS assessments.

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Section: Discussioncontrasting

confidence: 65%

“…15–18 In our sample, the motor score was the least reliable of the subcomponents. Proposed alternatives to the GCS that simplify assessment of consciousness include the FOUR score and the Emergency Coma Scale.…”

Section: Discussionmentioning

confidence: 66%

Randomized Controlled Trial of a Scoring Aid to Improve Glasgow Coma Scale Scoring by Emergency Medical Services Providers

Feldman

Hart

Lindsell

et al. 2015

Annals of Emergency Medicine

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“…For the critical outcome of likelihood of differentiating between minor head contusion and more serious concussion (brain injury), we identified very-low-quality evidence (downgraded for risk of bias and indirectness) from 1 observational study 160 with 19 408 patients in a trauma registry using a secondary analysis of rescoring prehospital Glasgow Coma Scale (GCS) scores showing no significant difference between a simple derived motor score versus the GCS score to determine brain injury.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…For the important outcome of need for advanced medical care (neurosurgical intervention and emergency tracheal intubation), we identified very-low-quality evidence (downgraded for imprecision) from 1 nonrandomized study 160 with 19 408 patients in a trauma registry using a secondary analysis of rescoring the prehospital GCS scores showing no significant difference between a simple derived motor score versus the GCS score for neurosurgical intervention (MD, 0.04; 95% CI, 0.01-0.09) and the need for emergency tracheal intubation (MD, 0.05; 95% CI, 0.01-0.11).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: First Aid

Em¹,

Da²,

Buck³

et al. 2015

Circulation

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and curriculum development, and a specialist in first aid evidence evaluation methodology and guideline development.The task force convened in June 2013 to review the topics and questions that were evaluated in 2005 and 2010, past research questions formulated in the PICO style (population, intervention, comparator, outcomes) that were never completed, and the new questions that had been submitted since 2010 to the task force, and a priority list created. Topics were reviewed for areas of controversy, known additional new science, and subject matter not previously evaluated. Task force members created a priority list for review, and the top 10 priority-ranked PICO questions were assigned. After the successful commencement of the workflow, the task force co-chairs added a further 12 PICO questions, including 5 new questions, 1 derived question, and 6 that had been previously reviewed. Selected PICO questions that had been previously reviewed were, in some cases, reworded to facilitate literature searches, and outcomes were decided upon by group consensus.Evidence reviewers were recruited through a call for volunteers distributed by ILCOR to stakeholder organizations around the world. More than 30 individual reviewers were assigned to topics, usually by preference or expertise, but avoiding any direct conflicts of interest. In general, 2 evidence reviewers were assigned to each PICO, supervised by a member of the task force designated as the task force question owner. Evidence reviewers included physicians with diverse specialties including emergency medicine, EMS, wilderness medicine, critical care, cardiology, occupational medicine, toxicology, anesthesia, pediatric emergency medicine, public health, and epidemiology, as well as paramedics, nurse practitioners and first aid education specialists with experience in guideline and curriculum development, and professional evidence evaluation and methodology experts. The Evidence Evaluation ProcessFor the 2015 international evidence evaluation process, the AHA developed a new Web-based information and documentation platform, the Systematic Evidence Evaluation and Review System (SEERS), to support the ILCOR systematic reviews and to capture the data in reusable formats. This Webbased system facilitated structured reviews in a consistent format that would support the ultimate development of science summaries and evidence-based treatment recommendations.Each task force performed a detailed systematic review based on the recommendations of the Institute of Medicine of the National Academies, 1 using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 After identifying and prioritizing the PICO questions to be addressed, 3 and with the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evalu...

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“…Recently, a simplified scoring system has been developed and validated in the prehospital setting (Thompson et al, 2011). The simplified motor score (SMS) is a three-point scoring system (Table 23.2) and has been found to predict outcomes in TBI with similar accuracy to the GCS (Thompson et al, 2011). In the future, the SMS may well replace the GCS in prehospital and hospital assessments of patients with TBI.…”

Section: The Glasgow Coma Scalementioning

confidence: 99%