Prehospital bruk av Glasgow Coma Scale i Ambulansetjenesten i Oslo og Akershus Bruk, feilkilder og begrensninger

Abstract

Background. Since its introduction in 1974, the Glasgow Coma Scale (GCS) has become the standard tool for mental status assessment and is widely accepted. The scale has been criticized because of its complexity and low interrater reliability. GCS has a poor predictive value when it comes to patients that are under alcohol or drug influence. We wanted to examine the use of GCS in the prehospital setting in terms of confounders and limitations. We focused on the written ambulance patient journals. Methods. We did a retrospective qualitative analysis of prehospital ambulance patient journals from an Oslo Ambulance Service. The lack of GCS score or written evaluation of patient consciousness, discrepancies between GCS score and the evaluation of the patient were classified as a deviation and divided into 3 groups, 1) insufficient GCS score, 2) insufficient written evaluation of the patient and 3) discrepancies between the GCS score and the written evaluation of the patient. Results. A total of 387 journals were included in this study. 27% (104) of the journals had a deviation in evaluation of patient consciousness. Deviations were most frequent in alcohol exposure, intoxication, fall accidents, dyspnea, chest pain and psychiatric disorders. Conclusion. A high number of the registered ambulance patient journals had one form of deviation according to our criteria. GCS is frequently used on alcohol-influenced or otherwise intoxicated patients, but there seems to be problems when it comes to interpretation of the score. Discrepancies between GCS and the patient evaluation were more frequent in states that affect the central nervous system (CNS) function. These are conditions in which GCS score is highly relevant. We assume that the complexity of GCS scoring and the tendency to subjective scoring based on the situation as a whole, are some of the reasons for the high number of deviations. Another source of deviations are differences in personal interpretations of consciousness and somnolent which are used in patient evaluation. This is consistent with previous research that indicates a low interrater reliability in GCS scoring. We recommed focus on correct use of the GCS in education of paramedics , in order to reduce confounders and improve interrater reliability. It is known that GCS is not an easy tool in clinical evaluation of patients in the prehospital setting, but we have not found a better clinical tool.

Background. Since its introduction in 1974, the Glasgow Coma Scale (GCS) has become the standard tool for mental status assessment and is widely accepted. The scale has been criticized because of its complexity and low interrater reliability. GCS has a poor predictive value when it comes to patients that are under alcohol or drug influence. We wanted to examine the use of GCS in the prehospital setting in terms of confounders and limitations. We focused on the written ambulance patient journals. Methods. We did a retrospective qualitative analysis of prehospital ambulance patient journals from an Oslo Ambulance Service. The lack of GCS score or written evaluation of patient consciousness, discrepancies between GCS score and the evaluation of the patient were classified as a deviation and divided into 3 groups, 1) insufficient GCS score, 2) insufficient written evaluation of the patient and 3) discrepancies between the GCS score and the written evaluation of the patient. Results. A total of 387 journals were included in this study. 27% (104) of the journals had a deviation in evaluation of patient consciousness. Deviations were most frequent in alcohol exposure, intoxication, fall accidents, dyspnea, chest pain and psychiatric disorders. Conclusion. A high number of the registered ambulance patient journals had one form of deviation according to our criteria. GCS is frequently used on alcohol-influenced or otherwise intoxicated patients, but there seems to be problems when it comes to interpretation of the score. Discrepancies between GCS and the patient evaluation were more frequent in states that affect the central nervous system (CNS) function. These are conditions in which GCS score is highly relevant. We assume that the complexity of GCS scoring and the tendency to subjective scoring based on the situation as a whole, are some of the reasons for the high number of deviations. Another source of deviations are differences in personal interpretations of consciousness and somnolent which are used in patient evaluation. This is consistent with previous research that indicates a low interrater reliability in GCS scoring. We recommed focus on correct use of the GCS in education of paramedics , in order to reduce confounders and improve interrater reliability. It is known that GCS is not an easy tool in clinical evaluation of patients in the prehospital setting, but we have not found a better clinical tool.