Effects of a scoring aid on glasgow coma score assessment and physicians' comprehension: a simulator-based randomized clinical trial - Kliem, P. S. C.; Tisljar, K.; Grzonka, P.; Berger, S.; Amacher, S. A.; De Marchis, G. M.; Dittrich, T. D.; Hunziker, S.; Ruegg, S.; Bassetti, S.; Bingisser, R.; Marsch, S.; et al. (J Neurol, 2024)
PURPOSE: Examining the impact of scoring aids on the accuracy of assessing the Glasgow Coma Score (GCS) in a standardized trauma scenario (primary outcome). Evaluating physicians' understanding of the GCS assessment and clinical application (secondary outcome). MATERIALS AND METHODS: This randomized trial was performed at the simulator center of a Swiss tertiary academic medical hospital. Participants included intensivists, emergency physicians, internists, and neurologists. The setting involved a trauma patient portraying a GCS of 8 (eyes 1, verbal 2, motor 5). Participants were randomized to receiving or not receiving a scoring aid. Video/audio recordings of the assessments and questionnaires were analyzed by two investigators. RESULTS: Among 109 participants, 55 received a scoring aid. Overall, 52% scored correctly (score interquartile range 7-8); 43% scored too low and 90% scored within a range of +/- 1. A scoring aid increased accuracy (62% vs. 43%, p = 0.045) and participants' confidence, whilst decreasing assessment duration. Clinical experience further improved reliability. 89% found assessing a GCS of 8 most challenging, particularly with motor response evaluation (64%). 26% indicated tracheal intubation to be mandatory with a score of GCS </= 8. CONCLUSIONS: GCS assessment is improved by professional experience and a scoring aid, the use of which needs to be promoted in daily clinical practice. Frequent inaccuracy and misunderstanding regarding clinical applications may alter patient management and misguide treatment and prognosis. TRIAL REGISTRATION: ISRCTN registry (IDISRCTN12257237) https://www.isrctn.com/ISRCTN12257237 Retrospectively registered (last amendment 08/22/2023).
Keywords: journalArticle; (SSGIM). Stephan Ruegg received unconditional research grants from UCB-pharma. He; (according to article 51(2) of the Human Research Act). Consent was received from; (payments from UCB). Stefano Bassetti reports no disclosures. Roland Bingisser; *Glasgow Coma Scale/standards; *Physicians/standards; 10001C_192850/1 and 10531C_182422), the Gottfried Julia Bangerter-Rhyner; 33CM30_140338/1; Adult; BMS/Pfizer. Tolga Dittrich was or is supported by the Swiss Heart Foundation, the; Bangerter-Rhyner-Stiftung; Berger reports no disclosures. Simon Amacher is supported by the Mach-Gaensslen; Clinical Competence/standards; Comprehension/physiology; De Quervain research grant; Eisai, and UCB-pharma, and from serving as a consultant for Arvelle, Eisai,; Ethics approval and consent to participate: The study was approved by the local; Female; Fondazione Dr. Ettore Balli; Foundation (8472/HEG-DSV), and the Swiss Society of General Internal Medicine; Foundation Switzerland and the Nora van Meeuwen-Haefliger Foundation of the; Glasgow Coma Score; Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from; Humans; Intensive care; Johnson & Johnson, Roche, Lilly, Bristol-Myers Squibb, Merck, and Novo Nordisk; League against Epilepsy) (no payments), and Editor of the Swiss EEG Bulletin; Male; Middle Aged; Neurocritical care; Pfizer, Novartis, Sandoz, and UCB-pharma. He does not hold any stocks of any; Randomized controlled trial; Reporting Trials) and STROBE (Strengthening The Reporting of OBservational; Reproducibility of Results; Sabina Hunziker is supported by the Swiss National Foundation (SNF) (Ref; Science Funds [Wissenschaftsfonds] of the; Simulation Research-and extensions to the CONSORT (CONsolidated Standards Of; Swiss Neurological Society; Swisslife Jubilaumsstiftung for Medical Research; Thermo Fisher GmbH. He; Tisljar reports no disclosures. Pascale Grzonka reports no disclosures. Sebastian; UCB-pharma and holds stocks from Novartis, Roche, Alcon, and Johnson & Johnson; University Hospital Basel and University of Basel; University of Basel, Switzerland. Gian Marco De Marchis was or is supported by; against Epilepsy (no payments), Editor of EPILEPTOLOGIE (Journal of the Swiss; digital SRCTN registry (ID ISRCTN12257237) [20]. Consent for publication: Consent; ethics committee (EKNZRequ_2019-00168), who ascertained that this study complies; excellent young researchers of the University of Basel. He holds shares from; for publication was obtained from our author P.G. (seen in the picture) to; funding from UCB-pharma, and Swiss National Science Foundation Grants: grant; he disclosed that he is the past president of the Swiss League; number 320030_169379/1 and coapplicant for grants numbers 33CM30_125115/1 and; pharmaceutical industries or manufacturers of medical devices. He received; portray a participating physician in Fig. 1.; received honoraria from serving on the scientific advisory boards of Arvelle,; received research grants from the Swiss National Foundation (No 320030_169379),; received travel honoraria by Bayer and speaker honoraria by Medtronic and; recordings of their performances. The Reporting Guidelines for Health Care; reports no disclosures. Stephan Marsch reports no disclosures. Raoul Sutter; science funds of the University Hospital Basel, and the Research fund for