Abstract
Purpose
We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS)
conveys most of the predictive information of triage scores (Triage Revised Trauma
Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma
patients.
Method
We conducted a multicenter prospective observational study and evaluated 1690 trauma
patients in 14 centers. We compared the GCS, T-RTS, MGAP, and Trauma Related Injury
Severity Score (reference standard) using the full GCS or its motor component only
using logistic regression model, area under the receiver operating characteristic
curve, and reclassification technique.
Results
Although some changes were noted for the GCS itself and the Trauma Related Injury
Severity Score, no significant change was observed using the motor component only
for T-RTS and MGAP when considering (1) the odds ratio of variables included in the
logistic model as well as their discrimination and calibration characteristics, (2)
the area under the receiver operating characteristic curve (0.827 ± 0.014 vs 0.831
± 0.014, P = .31 and 0.863 ± 0.011 vs 0.859 ± 0.012, P = .23, respectively), and (3) the reclassification technique. Although the mortality
rate remained less than the predetermined threshold of 5% in the low-risk stratum,
it slightly increased for MGAP (from 1.9% to 3.9%, P = .048).
Conclusion
The use of the motor component only of the GCS did not change the global performance
of triage scores in trauma patients. However, because a subtle increase in mortality
rate was observed in the low-risk stratum for MGAP, replacing the GCS by its motor
component may not be recommended in every situation.
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Article Info
Publication History
Published online: October 31, 2011
Accepted:
June 25,
2011
Received:
May 24,
2011
Footnotes
☆This study was supported by the Programme Hospitalier de Recherche Clinique 2003 of the French Ministry of Health (National PHRC), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Centre Hospitalier Universitaire de Dijon .
☆☆The authors have declared no conflict of interest.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
