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首页> 外文期刊>The journal of trauma and acute care surgery >Evidence-based improvement of the National Trauma Triage Protocol: The Glasgow Coma Scale versus Glasgow Coma Scale motor subscale
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Evidence-based improvement of the National Trauma Triage Protocol: The Glasgow Coma Scale versus Glasgow Coma Scale motor subscale

机译：全国性创伤分诊规程的循证改进：格拉斯哥昏迷量表与格拉斯哥昏迷量表的运动量表

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Background: Ideal triage uses simple criteria to identify severely injured patients. Glasgow Coma Scale motor (GCSm) may be easier for field use and was considered for the National Trauma Triage Protocol (NTTP). This study evaluated performance of the NTTP if GCSm is substituted for the current GCS score ≤ 13 criterion. Methods: Subjects in the National Trauma Data Bank undergoing scene transport were included. Presence of NTTP physiologic (Step 1) and anatomic (Step 2) criteria was determined. GCSm score ≤ 5 was defined as a positive criterion. Trauma center need (TCN) was defined as Injury Severity Score (ISS) > 15, intensive care unit admission, urgent operation, or emergency department death. Test characteristics were calculated to predict TCN. Area under the curve was compared between GCSm and GCS scores, individually and within the NTTP. Logistic regression was used to determine the association of GCSm score ≤ 5 and GCS score ≤ 13 with TCN after adjusting for other triage criteria. Predicted versus actual TCN was compared. Results: There were 811,143 subjects. Sensitivity was lower (26.7% vs. 30.3%), specificity was higher (95.1% vs. 93.1%), and accuracy was similar (66.1% vs. 66.3%) for GCSm score ≤ 5 compared with GCS score ≤ 13. Incorporated into the NTTP Steps 1 + 2, GCSm score ≤ 5 traded sensitivity (60.4% vs. 62.1%) for specificity (67.1% vs. 65.7%) with similar accuracy (64.2% vs. 64.2%) to GCS score ≤ 13. There was no difference in the area under the curve between GCSm score ≤ 5 and GCS score ≤ 13 when incorporated into the NTTP Steps 1 + 2 (p = 0.10). GCSm score ≤ 5 had a stronger association with TCN (odds ratio, 3.37; 95% confidence interval, 3.27-3.48; p < 0.01) than GCS score ≤ 13 (odds ratio, 3.03; 95% confidence interval, 2.94-3.13; p < 0.01). GCSm had a better fit of predicted versus actual TCN than GCS at the lower end of the scales. Conclusion: GCSm score ≤ 5 increases specificity at the expense of sensitivity compared with GCS score ≤ 13. When applied within the NTTP, there is no difference in discrimination between GCSm and GCS. GCSm score ≤ 5 is more strongly associated with TCN and better calibrated to predict TCN. Further study is warranted to explore replacing GCS score ≤ 13 with GCSm score ≤ 5 in the NTTP.
机译：背景：理想分流使用简单的标准来识别严重受伤的患者。格拉斯哥昏迷量表电动机（GCSm）可能更易于在野外使用，并已被考虑用于《国家创伤分类法》（NTTP）。如果GCSm替代了当前的GCS得分≤13，则本研究评估了NTTP的性能。方法：纳入国家创伤数据库中进行现场运输的受试者。确定了NTTP生理（步骤1）和解剖（步骤2）标准的存在。 GCSm得分≤5被定义为阳性标准。创伤中心需求（TCN）定义为伤害严重度评分（ISS）> 15，重症监护病房入院，紧急手术或急诊科死亡。计算测试特征以预测TCN。在GCSm和GCS分数之间，分别在NTTP内比较曲线下的面积。在采用其他分类标准进行调整后，使用Logistic回归确定GCSm得分≤5和GCS得分≤13与TCN的相关性。比较了预测的TCN与实际的TCN。结果：共有811,143名受试者。与GCS分数≤13相比，GCSm分数≤5的敏感性较低（26.7％对30.3％），特异性较高（95.1％对93.1％），准确性相似（66.1％对66.3％）。 NTTP步骤1 + 2，GCSm得分≤5的特异性（67.1％VS. 65.7％）的敏感性（60.4％vs. 62.1％）达到了GCS得分≤13的相似准确性（64.2％vs. 64.2％）。当纳入NTTP步骤1 + 2（p = 0.10）时，GCSm得分≤5和GCS得分≤13之间的曲线下面积无差异。 GCSm得分≤5与TCN的关联性更高（比值比为3.37; 95％置信区间为3.27-3.48; p <0.01）比GCS得分≤13（比值比为3.03; 95％置信区间为2.94-3.13; p <0.01）。 GCSm比低端的GCS更适合预测TCN和实际TCN。结论：与GCS分数≤13相比，GCSm分数≤5增加了特异性，但以敏感性为代价。当在NTTP中应用时，GCSm和GCS的区别没有差异。 GCSm得分≤5与TCN关联更强，并且可以更好地校准以预测TCN。有必要进行进一步的研究，以探索在NTTP中用GCSm得分≤5替代GCS得分≤13。

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