Inter-rater reliability of Glasgow Coma Scale at a Referral Care Facility in Uganda: effect of an educational intervention among health workers

TL;DR

This study shows that an educational tool improves consistency in using the Glasgow Coma Scale among health workers in Uganda.

Contribution

The study introduces a GCS-AID educational intervention that improves inter-rater reliability in low-resource settings.

Findings

Higher training levels increased knowledge of GCS (F = 3.753, p = 0.01).

The GCS-AID improved inter-rater reliability, with eye-opening showing the greatest improvement (α, 0.65-0.88).

Post-intervention, verbal and motor scores showed improved reliability (0.74 to 0.89 and 0.83 to 0.93 respectively).

Abstract

The Glasgow Coma Scale is a widely used tool in the assessment and tracking of patients with acute head and brain insults. However, its reliability and application in low-resource clinical settings have been least explored.

The study aimed at determining the IRR of GCS among health workers and evaluating the effect of a standardized GCS Aid as an educational intervention in improving the accuracy and IRR of the GCS when assessing patients with neurological deficits at a tertiary facility in Uganda.

The study employed a pre-test, post-test quasi-experimental design. Participants included health workers working within wards with adult patients with acute brain insults. A total of 45 participants completed the study.

Findings indicate that higher training levels increased knowledge of GCS (F = 3.753, p = 0.01). The GCS AID improved the accuracy and IRR of the GCS post-test with eye-opening showing the greatest improvement (α, 0.65-0.88) followed by verbal (0.74 to 0.89), motor (0.83 to 0.93).

The use of the GCS-AID improved the IRR of GCS among health workers in the assessment of patients with acute brain insults.

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