Date of Graduation

Summer 8-10-2019

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: To assess an injured patient’s condition and to triage the patient to the appropriate facility, out-of-hospital providers use the Glasgow Coma Scale (GCS) even though the GCS has known inconsistent results. A GSC motor (GCS-m) less than 6 or “patient does not follow commands” would be an acceptable substitution to the full GCS to simplify trauma triage.

Method: An exhaustive literature search using MEDLINE-Ovid, Web Science, and CINAHL was conducted. The following search terms were used: “patient does not follow commands” and “Glasgow Coma Scale” which yielded 2 studies. Studies were assessed for quality using GRADE criteria.

Results: Studies confirmed that a simpler determination of “patient does not follow commands” can be as accurate as the total GCS score. One study showed that the difference between total GCS score less than or equal to 13 and GCS-m score less than 6 or “patient does not follow commands” were below their prespecified 5% threshold and thus clinically unimportant. The full GCS scale was found to be more sensitive and slightly less specific than the GCS-m score less than 6 for predicting an injury severity scale (ISS) greater than 15, with overall similar accuracy. Another study validated that GCS-m score less than 6 or “patient does not follow commands” had similar accuracy to the full GCS scale for multiple trauma outcomes, and the graphed sensitivity versus specificity was nearly identical for the GCS-m less than 6 and full GCS scores.

Conclusion: The simpler determination of GCS-m less than 6 or “patient does not follow commands” effectively predicts serious injury similarly to the more complicated total GCS score. The differences in specificity and sensitivity between GCS-m score less than 6 and total GCS score were similar, and accuracy were the same. It is recommended that the simpler “patient does not follow commands” replace the total GCS for out-of-hospital trauma triage.

Keywords: Glasgow Coma Scale and “patient does not follow commands”

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