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A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics.

Publication ,  Journal Article
Hunt, IE; Wittenberg, BE; Kennamer, B; Crutcher, CL; Tender, GC; Hunt, JP; DiGiorgio, AM
Published in: World Neurosurg
July 2022

BACKGROUND: The Glasgow Coma Scale (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) with that recorded in the neurosurgery consultation (GCS-2). METHODS: This retrospective review compared GCS-1 with GCS-2. The Trauma Injury Severity Score (TRISS) method was used to calculate probability of survival (POS) for patients using both GCS-1 and GCS-2. RESULTS: GCS-1 score significantly differed from GCS-2 score (6.69 vs. 7.84, ± 2.553; P < 0.001). There were 172 patients (37.55%) with a GCS-1 score of 3 and 87 (19.00%) with a GCS-2 score of 3 (χ2P < 0.001). The POS calculated using TRISS methodology with GCS-1 (POS-1) was 74.7% ± 26.6% compared with GCS-2 (POS-2), which was 79.3% ± 24.4%. There was a statistically significant difference in the means of POS-2 and POS-2 (P < 0.001). The actual observed survival for the cohort was 71.0% (325/458). CONCLUSIONS: The immediate GCS score recorded on patient arrival after trauma differs significantly from the GCS score recorded at later times. This finding significantly altered the probability of survival as calculated by the TRISS methodology. This situation could have profound effects on risk-adjusted benchmarking, assessments of quality of care, and injury severity stratification for research. More studies into the optimal timing of GCS score recording or changes in GCS score and their impact on survival are warranted.

Duke Scholars

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

July 2022

Volume

163

Start / End Page

e559 / e564

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Care
  • Humans
  • Glasgow Coma Scale
  • Documentation
  • Benchmarking
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hunt, I. E., Wittenberg, B. E., Kennamer, B., Crutcher, C. L., Tender, G. C., Hunt, J. P., & DiGiorgio, A. M. (2022). A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics. World Neurosurg, 163, e559–e564. https://doi.org/10.1016/j.wneu.2022.04.019
Hunt, Iris E., Blake E. Wittenberg, Brooke Kennamer, Clifford L. Crutcher, Gabriel C. Tender, John P. Hunt, and Anthony M. DiGiorgio. “A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics.World Neurosurg 163 (July 2022): e559–64. https://doi.org/10.1016/j.wneu.2022.04.019.
Hunt IE, Wittenberg BE, Kennamer B, Crutcher CL, Tender GC, Hunt JP, et al. A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics. World Neurosurg. 2022 Jul;163:e559–64.
Hunt, Iris E., et al. “A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics.World Neurosurg, vol. 163, July 2022, pp. e559–64. Pubmed, doi:10.1016/j.wneu.2022.04.019.
Hunt IE, Wittenberg BE, Kennamer B, Crutcher CL, Tender GC, Hunt JP, DiGiorgio AM. A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics. World Neurosurg. 2022 Jul;163:e559–e564.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

July 2022

Volume

163

Start / End Page

e559 / e564

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Care
  • Humans
  • Glasgow Coma Scale
  • Documentation
  • Benchmarking
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences