Comparison of Prehospital Versus Arrival Glasgow Coma Scale Scores Among Trauma Patients: A Retrospective Analysis

TL;DR

This study compares prehospital and arrival Glasgow Coma Scale scores in trauma patients to assess agreement and factors affecting it.

Contribution

The study provides new insights into the agreement of GCS scores between prehospital and ED assessments, particularly in intoxicated patients and by transport method.

Findings

Overall agreement between prehospital and arrival GCS scores was moderate (kappa 0.54).

Alcohol intoxication reduced agreement to moderate levels (kappa 0.57).

Ground EMS had lower pGCS than aGCS, while air EMS had higher pGCS.

Abstract

Introduction: The Glasgow Coma Scale (GCS) is a valuable tool that has long been used to help identify critically ill trauma patients in the prehospital setting. A discrepancy was observed by emergency medicine staff in prehospital GCS (pGCS) versus arrival GCS (aGCS). This observed discrepancy in GCS has important implications in the proper triage of trauma patients, including the appropriate level of activation, resource utilization, and cost.

Study objective: The aim of the study was to determine the level of agreement between pGCS and aGCS among trauma patients, determine the effect of alcohol intoxication on GCS agreement, analyze for differences in GCS among methods of transport, and limit confounding variables in the patient population.

Methods: A single-center retrospective cohort of 2,531 trauma patients aged 14 and older who presented as level 1 and level 2 trauma alerts was included. To determine agreement, component, total, and categorical GCS scores were compared using weighted Cohen’s kappa. In addition, the effect on agreement among acutely intoxicated trauma patients was assessed. Finally, absolute differences in mean scores stratified by method of transport were also evaluated.

Results: The study included 2,531 patients. Overall agreement between pGCS and aGCS was moderate (kappa 0.54) with substantial agreement (kappa 0.67) when categorized by severity. Alcohol intoxication decreased agreement to moderate agreement (kappa 0.57). pGCS tended to be lower than aGCS for ground Emergency Medical Services (EMS) (-0.45) and higher for air EMS (0.7).

Conclusion: GCS agreement between prehospital and emergency department (ED) providers is similar, with variation among methods of transport and patients who are acutely intoxicated; however, this difference may not be clinically significant.