Problems with initial Glasgow Coma Scale assessment
caused by prehospital treatment of patients with head injuries:
results of a national survey.
Marion DW, Carlier PM.
Department of Neurological Surgery, University of Pittsburgh
School of Medicine.
The rapid treatment of patients with a severe head injury
often includes prehospital intubation and sedation, but such
measures compromise the ability to obtain an accurate Glasgow
Coma Scale (GCS) score in the emergency department (ED).
Major head injury centers in the United States were surveyed
to determine how they currently obtain initial GCS scores when
these or other complicating circumstances exist.
A two-page questionnaire was distributed to seven members
of the trauma team at 17 major neurotrauma centers in which
they were asked who usually determines the initial GCS score,
where they are assessed, and when. Respondents were also asked
how they assign scores for patients who received medications
or were intubated before arrival at their hospital and how they
score patients who are hypotensive, hypoxic, or have severe
periorbital swelling.
Most centers assess the initial GCS scores in their ED within
1 hour after the discovery of the patient by prehospital personnel.
Most neurosurgeons said that hypotension and hypoxia are stabilized
before the initial GCS scores are assessed and that intubated
patients receive a non-numerical designation.
But the majority of non-neurosurgical ED personnel said that
they determine the initial GCS scores immediately after arrival
of the patients in their department, regardless of hypoxia or
hypotension. There also were significant discrepancies between
attending neurosurgeons and their residents with regard to who
actually assesses the GCS scores and how the scores are determined
for patients who have received neuromuscular paralysis or sedation
or who have severe periorbital swelling.
