Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes After Traumatic Brain Injury - 19/10/11
Résumé |
Study objective |
The Glasgow Coma Scale (GCS) score is widely used to assess patients with head injury but has been criticized for its complexity and poor interrater reliability. A 3-point Simplified Motor Score (SMS) (defined as obeys commands=2, localizes pain=1, and withdraws to pain or worse=0) was created to address these limitations. Our goal is to validate the SMS in the out-of-hospital setting, with the hypothesis that it is equivalent to the GCS score for discriminating brain injury outcomes.
Methods |
This was a secondary analysis of an urban Level I trauma registry. Four outcomes and their composite were studied: emergency tracheal intubation, clinically meaningful brain injury, need for neurosurgical intervention, and mortality. The out-of-hospital GCS score and SMS were evaluated by comparing areas under the receiver operating characteristic curve with a paired nonparametric approach. Multiple imputation was used for missing data. A clinically significant difference in areas under the receiver operating characteristic curve was defined as greater than or equal to 0.05, according to previous literature.
Results |
We included 19,408 patients, of whom 18% were tracheally intubated, 18% had brain injuries, 8% required neurosurgical intervention, and 6% died. The difference between the area under the receiver operating characteristic curve for the out-of-hospital GCS score and SMS was 0.05 (95% confidence interval [CI] −0.01 to 0.11) for emergency tracheal intubation, 0.05 (95% CI 0 to 0.09) for brain injury, 0.04 (95% CI −0.01 to 0.09) for neurosurgical intervention, 0.08 (95% CI 0.02 to 0.15) for mortality, and 0.05 (95% CI 0 to 0.10) for the composite outcome.
Conclusion |
In this external validation, SMS was similar to the GCS score for predicting outcomes in traumatic brain injury in the out-of-hospital setting.
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Supervising editor: Steven M. Green, MD |
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Author contributions: TRH, RLB, and JSH conceived the study, designed the trial, and obtained institutional review board approval. CG and JSH supervised the data collection. CG managed the data, including quality control. TRH, MML, RLB, and JSH provided statistical advice on study design and analyzed the data. DOT and MML drafted the article, and all authors contributed substantially to its revision. DOT takes responsibility for the paper as a whole. |
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Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Liao was supported by the Agency for Healthcare Research and Quality (AHRQ) (F32 HS018123), as was Dr. Haukoos (K02 HS017526). |
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Please see page 418 for the Editor's Capsule Summary of this article. |
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Publication date: Available online July 30, 2011. |
Vol 58 - N° 5
P. 417-425 - novembre 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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