Prehospital versus Emergency Department Glasgow Coma Scale in Blunt Traumatic Brain Injury: A Retrospective Review of the National Trauma Data Bank

Abstract

Introduction

Previous studies have demonstrated variability between prehospital (PH) and Emergency Department (ED) Glasgow Coma Scale (GCS) for patients suffering traumatic brain injuries (TBIs). Understanding the relationship between PH and ED GCS, as well as the factors that may contribute to any observed differences, is crucial for optimizing trauma triage protocols and resource allocation.

Methods

The National Trauma Data Bank (NTDB) was surveyed for adults aged ≥18 years following blunt TBI. PH and ED GCS scores were compared, including subgroup analysis of different TBI severities, Injury Severity Score (ISS), transport time, trauma verification level, intoxication, ICP monitor use, and mortality.

Results

419 145 patients were included. Overall, there was no difference in median PH and ED GCS (15 vs 15, z = 0.00, P = 1.00), with substantial agreement (κ_w = 0.759, P < .001). For mild TBI, there was fair agreement between PH and ED GCS (κ_w = 0.409, P < .001); for moderate TBI, there was moderate agreement (κ_w = 0.569, P < .001); and for severe TBI, there was substantial agreement (κ_w = 0.665, P < .001). Alcohol and drug intoxication, mortality, need for ICP monitor, and transport times were associated with differences in PH vs ED GCS, while ISS was not.

Discussion

PH and ED providers overall score patients similarly for GCS. While some minor differences were seen for certain subgroups (mild and severe TBI, mortality, alcohol or drug intoxication, transport times), these differences are likely not clinically significant.