The relationship between pre-hospital and emergency department Glasgow coma scale scores

Introduction: Pre-hospital GCS scores are used to make critical patient care decisions and to fill in gaps in hospital-based TBI surveillance, but they may not be accurate. Objective: To determine the relationship between pre-hospital (EMS-GCS) and emergency physician GCS scores (ED-GCS). Methods: Prospective observational study of 60 TBI patients with a field GCS of 8-13 and age > 18. ED-GCS, EMS-GCS, time of GCS and vitals signs were recorded. Analysis: Simple and multiple linear regression. Results: The median EMS-GCS was 13 and that for ED-GCS was 15. There was a significant linear relationship between ED-GCS and EMS-GCS (r = 0.45, p = 0.003). There was improvement in the prediction of ED-GCS when alcohol/drug use and age (but not time) were added to EMS-GCS. Conclusion: EMS-GCS is usually two points lower than ED-GCS, but the correlation between them is strong and independent of the time between score determinations. These results could prevent unnecessary procedures based on the EMS-GCS and improve the accuracy of TBI surveillance.