Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2023

Open Access 09-06-2023 | Coma | Original Article

Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale

Authors: Dimitrios M. Anestis, Konstantinos Marinos, Parmenion P. Tsitsopoulos

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2023

Login to get access

Abstract

Background

Various tools simpler than the Glasgow Coma Scale (GCS) have been proposed for the assessment of consciousness. In this study, the validity of three coma scales [Simplified Motor Scale, Modified GCS Motor Response, and AVPU (alert, verbal, painful, unresponsive)] is evaluated for the recognition of coma and the prediction of short- and long-term mortality and poor outcome. The predictive validity of these scales is also compared to the GCS.

Methods

Patients treated in the Department of Neurosurgery and the Intensive Care Unit in need of consciousness monitoring were assessed by four raters (two consultants, a resident and a nurse) using the GCS. The corresponding values of the simplified scales were estimated. Outcome was recorded at discharge and at 6 months. Areas Under the Receiver Operating Characteristic Curve (AUCs) were calculated for the prediction of mortality and poor outcome, and the identification of coma.

Results

Eighty-six patients were included. The simplified scales showed good overall validity (AUCs > 0.720 for all outcomes of interest), but lower than the GCS. For the identification of coma and the prediction of long-term poor outcome, the difference was significant (p < 0.050) for all the ratings of the most experienced rater. The validity of these scales was comparable to the GCS only in predicting in-hospital mortality, but without this being consistent for all raters.

Conclusion

The simplified scales showed inferior validity than the GCS. Their potential role in clinical practice needs further investigation. Thus, the replacement of the GCS as the main scale for consciousness assessment cannot be currently supported.
Literature
1.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.PubMedCrossRef
2.
Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34(1–4):45–55.PubMedCrossRef
3.
Kornbluth J, Bhardwaj A. Evaluation of coma: a critical appraisal of popular scoring systems. Neurocrit Care. 2011;14(1):134–43.PubMedCrossRef
4.
Matis G, Birbilis T. The Glasgow Coma Scale—a brief review. Past, present, future. Acta Neurol Belg. 2008;108(3):75–89.PubMed
5.
Laureys S, Bodart O, Gosseries O. The Glasgow Coma Scale: time for critical reappraisal? Lancet Neurol. 2014;13(8):755–7.PubMedCrossRef
6.
Moore SA, Wijdicks EF. The acutely comatose patient: clinical approach and diagnosis. Semin Neurol. 2013;33(2):110–20.PubMedCrossRef
7.
8.
Gill M, Steele R, Windemuth R, Green SM. A comparison of five simplified scales to the out-of-hospital Glasgow Coma Scale for the prediction of traumatic brain injury outcomes. Acad Emerg Med. 2006;13(9):968–73.PubMedCrossRef
9.
Gill M, Martens K, Lynch EL, Salih A, Green SM. Interrater reliability of 3 simplified neurologic scales applied to adults presenting to the emergency department with altered levels of consciousness. Ann Emerg Med. 2007;49(4):403-7.e1.PubMedCrossRef
10.
Kelly CA, Upex A, Bateman DN. Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the glasgow coma scale. Ann Emerg Med. 2004;44(2):108–13.PubMedCrossRef
11.
McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale. Anaesthesia. 2004;59(1):34–7.PubMedCrossRef
12.
Eftekhar B, Zarei MR, Ghodsi M, MoezArdalan K, Zargar M, Ketabchi E. Comparing logistic models based on modified GCS motor component with other prognostic tools in prediction of mortality: results of study in 7226 trauma patients. Injury. 2005;36(8):900–4.PubMedCrossRef
13.
Hopkins E, Green SM, Kiemeney M, Haukoos JS. A two-center validation of “Patient Does Not Follow Commands” and three other simplified measures to replace the glasgow coma scale for field trauma triage. Ann Emerg Med. 2018;72(3):259–69.PubMedCrossRef
14.
Green SM. Cheerio, laddie! bidding farewell to the Glasgow Coma Scale. Ann Emerg Med. 2011;58(5):427–30.PubMedCrossRef
15.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef
16.
Rankin J. Cerebral vascular accidents in patients over the age of 60: III. Diagnosis and treatment. Scott Med J. 1957;2(6):255–68.CrossRef
17.
Van Swieten J, Koudstaal P, Visser M, Schouten H, Van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–7.PubMedCrossRef
18.
Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. The Lancet. 1975;305(7905):480–4.CrossRef
19.
Jennett B, Snoek J, Bond M, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981;44(4):285–93.PubMedPubMedCentralCrossRef
20.
Sadaka F, Patel D, Lakshmanan R. The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care. 2012;16(1):95–101.PubMedCrossRef
21.
Chen B, Grothe C, Schaller K. Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness. Acta Neurochir (Wien). 2013;155(11):2133–9 (discussion 9).PubMedCrossRef
22.
23.
Haukoos JS, Gill MR, Rabon RE, Gravitz CS, Green SM. Validation of the Simplified Motor Score for the prediction of brain injury outcomes after trauma. Ann Emerg Med. 2007;50(1):18–24.PubMedCrossRef
24.
Brunker C, Harris R. How accurate is the AVPU scale in detecting neurological impairment when used by general ward nurses? An evaluation study using simulation and a questionnaire. Intensive Crit Care Nurs. 2015;31(2):69–75.PubMedCrossRef
25.
Anestis DM, Foroglou NG, Varoutis PC, Monioudis PM, Tsonidis CA, Tsitsopoulos PP . Comparison of the prognostic value of coma scales among health-care professionals a prospective observational study. Acta Neurol Belg. 2023;123(3):893–902.PubMedCrossRef
26.
Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58(4):585–93.PubMedCrossRef
27.
Wolf CA, Wijdicks EF, Bamlet WR, McClelland RL. Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clin Proc. 2007;82(4):435–8.PubMedCrossRef
28.
Okasha AS, Fayed AM, Saleh AS. The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury. Neurocrit Care. 2014;21(3):496–504.PubMedCrossRef
29.
Singh B, Murad MH, Prokop LJ, Erwin PJ, Wang Z, Mommer SK, et al. Meta-analysis of Glasgow coma scale and simplified motor score in predicting traumatic brain injury outcomes. Brain Inj. 2013;27(3):293–300.PubMedCrossRef
30.
Chou R, Totten AM, Carney N, Dandy S, Fu R, Grusing S, et al. Predictive utility of the total Glasgow coma scale versus the motor component of the Glasgow coma scale for identification of patients with serious traumatic injuries. Ann Emerg Med. 2017;70(2):143-57.e6.PubMedCrossRef
31.
de Long ER, de Long DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRef
32.
Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315–6.PubMedCrossRef
33.
Mansour OY, Megahed MM, Abd Elghany EHS. Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit. Alex J Med. 2015;51(3):247–53.
34.
Wijdicks EF, Kramer AA, Rohs T Jr, Hanna S, Sadaka F, O’Brien J, et al. Comparison of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in predicting mortality in critically ill patients. Crit Care Med. 2015;43(2):439–44.PubMedCrossRef
35.
Said T, Chaari A, Hakim KA, Hamama D, Casey WF. Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: a pilot study. Int J Crit Illn Inj Sci. 2016;6(4):172.PubMedPubMedCentralCrossRef
36.
37.
Saito M, Seo Y, Yano Y, Momose K, Hirano H, Yoshida M, et al. Reduction in non-protein respiratory quotient is related to overall survival after hepatocellular carcinoma treatment. PLoS ONE. 2013;8(3): e55441.PubMedPubMedCentralCrossRef
38.
Anestis DM, Monioudis PM, Foroglou NG, Tsonidis CA, Tsitsopoulos PP. Clinimetric study and review of the reaction level scale. Acta Neurolog Scand. 2022;145(6,):706–20.CrossRef
39.
Fulton JA, Greller HA, Hoffman RS. GCS and AVPU: the alphabet soup doesn’t spell “COMA” in toxicology. Ann Emerg Med. 2005;45(2):224–5.PubMedCrossRef
40.
Anderson E, Kryzanski J. Prognosis and futility in neurosurgical emergencies: a review. Clin Neurol Neurosurg. 2020;195: 105851.PubMedCrossRef
41.
Honeybul S, Gillett GR, Ho K. Futility in neurosurgery: a patient-centered approach. Neurosurgery. 2013;73(6):917–22.PubMedCrossRef
42.
Anestis DM, Tsitsopoulos PP, Foroglou NG, Tsatali MS, Marinos K, Theologou M, et al. Cross-cultural adaptation and validation of the greek version of the “Full Outline of Unresponsiveness Score”: a prospective observational clinimetric study in neurosurgical patients. Neurocrit Care. 2021;36(2):584–94.PubMedPubMedCentralCrossRef
Metadata
Title
Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale
Authors
Dimitrios M. Anestis
Konstantinos Marinos
Parmenion P. Tsitsopoulos
Publication date
09-06-2023
Publisher
Springer Berlin Heidelberg
Keyword
Coma
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02286-w

Other articles of this Issue 5/2023

European Journal of Trauma and Emergency Surgery 5/2023 Go to the issue

Original Article

Emergency thoracotomies in traumatic cardiac arrests following blunt trauma – experiences from a German level I trauma center

Original Article

The relationship between plate prominence and need for removal after volar plate osteosynthesis of distal radius fractures

Editorial

Acute mesenteric ischemia: diagnostic and therapeutic challenges

Original Article

Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample

Original Article

Total intravenous anesthesia for geriatric hip fracture with severe systemic disease

Original Article

Outcome of laparotomy and conservative treatment of patients with acute mesenteric venous ischemia with viable bowel