GCSm与GCSt在急诊创伤患者伤情评估中的信效度比较

Comparison of the reliability and validity of total Glasgow Coma Scale versus its motor component for the emergency department assessment of traumatic injuries

目的评价并比较格拉斯哥昏迷评分(GCS)总分(GCSt)与其运动反应评分(GCSm)在急诊创伤患者伤情评估中的信度和效度。方法选择GCSt≤13分且GCSm≤5分的261例创伤患者为研究对象。由经过培训的抢救护士和分诊护士分别独立对创伤患者伤情进行GCS评分,比较GCSm和GCSt的评定者间信度。效度分析通过比较GCSm和GCSt对创伤严重程度评分(ISS)≥16分、急诊死亡的预测价值。结果GCSm和GCSt的评定者间一致性分别为0.948、0.986。Bland-Altman分析显示,GSCm、GCSt评估值的95%的差值点均在95%一致性界限内。预测ISS≥16分时,GCSm与GCSt的灵敏度分别为75.56%、68.86%,特异度分别为71.30%、79.17%,AUC分别为0.763、0.773(均P>0.05);预测急诊死亡时,GCSm与GCSt的灵敏度分别为70.00%、70.00%,特异度分别为65.98%、74.27%,AUC分别为0.689、0.703(均P>0.05)。结论GCSm和GCSt在经过培训后急诊护士间表现出较好的评定者间一致性,GCSm与GCSt比较具有相似甚至更优的灵敏度;GCSm可成为GCSt在创伤患者伤情评估中的潜在替代工具。

Objective To evaluate the reliability and validity of total Glasgow Coma Scale(GCSt)versus the motor component(GCSm)alone for the emergency department assessment of traumatic injuries.Methods A total of 261 trauma patients with GCSt≤13 and GCSm≤5 were selected for the study.GCS scores of the patients were assessed independently by trained resuscitation nurses and triage nurses,and the inter-rater reliability was compared.Validity was determined by comparing the predictive value of the GCSm and GCSt for Injury Severity Score(ISS)≥16 and death in the emergency department.Results The inter-rater reliability(ICC)for GCSm and GCSt was 0.948 and 0.986,respectively.Bland-Altman analysis showed that both instruments had more than 95%of the points within the 95%limit of agreement.For predicting ISS≥16 points,the sensitivity for GCSm and GCSt was 75.56%and 68.86%,the specificity was 71.30%and 79.17%,and the AUC was 0.763 and 0.773,respectively(both P>0.05).For predicting death in the emergency department,the sensitivity for GCSm and GCSt was equal at 70.00%,the specificity was 65.98%and 74.27%,and the AUC was 0.689 and 0.703,respectively(both P>0.05).Conclusion For trauma victims,the GCSm and GCSt show good inter-rater agreement among trained emergency nurses,and GCSm is equivalent to or more sensitive than the full GCS.In view of its simplicity the motor component of the GCS should replace the GCS in assessment of traumatic injuries.