Randomized Controlled Trial of a Scoring Aid to Improve GCS Scoring by EMS Providers.

Annals of Emergency Medicine

PubMedID: 25199613

Feldman A, Hart KW, Lindsell CJ, McMullan JT. Randomized Controlled Trial of a Scoring Aid to Improve GCS Scoring by EMS Providers. Ann Emerg Med. 2015;65(3):325-329.e2.
STUDY OBJECTIVE
Emergency medical services (EMS) personnel frequently use the Glasgow Coma Scale (GCS) to assess injured and critically ill patients. This study assesses the accuracy of EMS providers' GCS scoring, as well as the improvement in GCS score 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 assigned one of 9 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. ?(2) And Student's t tests were used to compare groups.

RESULTS
Of 180 participants, 178 completed the study. Overall, 73 of 178 participants (41%) gave a GCS score that matched the expert consensus score. GCS score was correct in 22 of 88 (25%) cases without the scoring aid. GCS was correct in 51 of 90 (57%) cases with the scoring aid. Most (69%) of the total GCS scores fell within 1 point of the expert consensus GCS score. Differences in accuracy were most pronounced in scenarios with a correct GCS score of 12 or below. Subcomponent accuracy was eye 62%, verbal 70%, and motor 51%.

CONCLUSION
In this study, 60% of EMS participants provided inaccurate GCS score estimates. Use of a GCS scoring aid improved accuracy of EMS GCS score assessments.