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The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients

  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Benoît Vivien
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    University Paris Descartes-Paris 5, Service d'Aide Médicale Urgente (SAMU) 75 and Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire (CHU) Necker-Enfants Malades, Paris, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Jean-Michel Yeguiayan
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Université de Bourgogne, SAMU 21 and Trauma Critical Care Unit, CHU de Dijon, Dijon, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Yannick Le Manach
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Department of Anesthesiology and Critical Care, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Claire Bonithon-Kopp
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    INSERM CIE 01, Center of Clinical Investigation and Department of Clinical Epidemiology, CHU de Dijon, Dijon, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Sébastien Mirek
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Université de Bourgogne, SAMU 21 and Trauma Critical Care Unit, CHU de Dijon, Dijon, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Delphine Garrigue
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    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Department of Anesthesiology and Critical Care, CHU de Lille, Lille, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Marc Freysz
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Université de Bourgogne, SAMU 21 and Trauma Critical Care Unit, CHU de Dijon, Dijon, France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Bruno Riou
    Correspondence
    Corresponding author. Service d'Accueil des Urgences, CHU Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. Tel.: +33 1 42 17 72 49; fax: +33 1 42 17 72 69.
    Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
    Affiliations
    Université Pierre et Marie Curie-Paris 6, Department of Emergency Medicine and Surgery, CHU Pitié-Salpêtrière, APHP, Paris France
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  • Author Footnotes
    1 FIRST Study Investigators. See Appendix for the complete listing.
Published:October 31, 2011DOI:https://doi.org/10.1016/j.ajem.2011.06.022

      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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