Abstract WP330: Refining Prehospital Stroke Severity Measures: Is There Added Benefit to Combining Field Glasgow Coma Scale and Los Angeles Motor Score?

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Shauna Cheung ◽  
Kristina Shkirkova ◽  
David Liebeskind ◽  
Mark Sabra ◽  
Sidney Starkman ◽  
...  
Keyword(s):  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Stroke Severity ◽  
Motor Score ◽  
Coma Scale ◽  
Added Benefit

Abstract TP235: Deterioration and Improvement in the Field: Comparative Detection by Los Angeles Motor Scale and Glasgow Coma Scale in Acute, EMS-transported Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anita Tipirneni ◽  
Kristina Shkirkova ◽  
Nerses Sanossian ◽  
Sidney Starkman ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Intracranial Hemorrhage ◽  
Stroke Patients ◽  
Coma Scale ◽  
Acute Cerebral Ischemia ◽  
Stroke Evolution ◽  
Global Impression Of Change ◽  
Los Angeles Motor Scale

Background: Stroke evolution after hospital arrival is well characterized for acute cerebral ischemia and intracranial hemorrhage. But with the advent of patient routing to designated stroke centers, and of prehospital stroke therapeutic trials, it is important to characterize stroke evolution in the earliest, prehospital moments of onset. Initial studies have prehospital evolution using serial Glasgow Coma Scale (GCS) assessment; however, GCS assesses level of consciousness rather than focal deficits. Methods: In the NIH FAST-MAG trial database, we analyzed patient deficit evolution from time of first paramedic assessment to early post-arrival assessment in the ED, using serial scores on the GCS, serial scores on the Los Angeles Motor Scale (LAMS) (a prehospital stroke deficit measure), and the Paramedic Global Impression of Change (PGIC) score, a 5 point Likert paramedic-clinician score. Results: Among 1632 acute, EMS-transported neurovascular disease patients, 1,245 (76.3%) had a final diagnosis of acute cerebral ischemia and 387 (23.7%) of acute intracranial hemorrhage. Time of paramedic initial assessment was median 23 mins (IQR 14-41) after onset and time of early ED assessment 58 mins (IQR 46-78). Considering score changes by 2 or more as salient, overall the LAMS and GCS indicated approximately equal frequencies of prehospital deterioration (LAMS 11.1%, GCS 12.0%), but the LAMS indicated higher frequencies of prehospital improvement (LAMS 24.5% vs GCS 5.7%, p<0.001), due to the ceiling constraint of the GCS. The LAMS correlated more strongly than the GCS with the paramedic global impression of change among all patients, r=0.31 vs 0.19, and especially in acute cerebral ischemia patients, r=0.27 vs 0.08). The prehospital course differed by stroke subtype on the LAMS: acute cerebral ischemia: improved 30.7%, worsened 7.1%, stable 62.25%; intracranial hemorrhage: improved 4.5%, worsened 24.2%, stable 71.3%. Conclusions: Focal deficit scales are superior to the GCS in characterizing prehospital stroke evolution. Change in neurologic status occurs in more than one-third of acute stroke patients during transport and the early ED, with improvement more common in acute cerebral ischemia and deterioration more common in ICH.

Mortality by Decade in Trauma Patients with Glasgow Coma Scale 3

2011 ◽  
Vol 77 (10) ◽  
pp. 1342-1345 ◽  
Author(s):  
Eric J. Ley ◽  
Morgan A. Clond ◽  
Omar N. Hussain ◽  
Marissa Srour ◽  
James Mirocha ◽  
...  
Keyword(s):  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Trauma System ◽  
Mortality Rates ◽  
High Survival ◽  
Trauma Patients ◽  
Coma Scale ◽  
The Third ◽  
Aggressive Care ◽  
Improvement In Survival

The aim of this study was to assess how increasing age affects mortality in trauma patients with Glasgow Coma Scale (GCS) 3. The Los Angeles County Trauma System Database was queried for all patients aged 20 to 99 years admitted with GCS 3. Mortality was 41.8 per cent for the 3306 GCS 3 patients. Mortality in the youngest patients reviewed, those in the third decade, was 43.5 per cent. After logistic regression analysis, patients in the third decade had similar mortality rates to patients in the sixth (adjusted OR, 0.88; CI, 0.68 to 1.14; P = 0.33) and seventh decades (adjusted OR, 0.96; CI, 0.70 to 1.31; P = 0.79). A significantly lower mortality rate, however, was noted in the fifth decade (adjusted OR, 0.76; CI, 0.61 to 0.95; P = 0.02). Conversely, significantly higher mortality rates were noted in the eighth (adjusted OR, 1.93; CI, 1.38 to 2.71; P = 0.0001) and combined ninth/tenth decades (adjusted OR, 2.47; CI, 1.71 to 3.57; P < 0.0001). Given the high survival in trauma patients with GCS 3 as well as continued improvement in survival compared with historical controls, aggressive care is indicated for patients who present to the emergency department with GCS 3.

Meta-analysis of Glasgow Coma Scale and Simplified Motor Score in predicting traumatic brain injury outcomes

Brain Injury ◽  
2012 ◽  
Vol 27 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Balwinder Singh ◽  
M. Hassan Murad ◽  
Larry J. Prokop ◽  
Patricia J. Erwin ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Meta Analysis ◽  
Motor Score ◽  
Coma Scale ◽  
Injury Outcomes

scholarly journals Indication for mild therapeutic hypothermia based on an initial Glasgow Coma Scale motor score

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Toru Hifumi ◽  
Kenya Kawakita ◽  
Tomoya Okazaki ◽  
Satoshi Egawa ◽  
Yutaka Kondo ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Therapeutic Hypothermia ◽  
Mild Therapeutic Hypothermia ◽  
Motor Score ◽  
Coma Scale

scholarly journals Difference and efficacy of simplified motor scale compared to Glasgow coma scale

2021 ◽  
Author(s):  
Tammam Mozher Aldarwish ◽  
Mohammed Abdulaziz Alowaidhi ◽  
Naish Abdullah Alghamdi ◽  
Ahmed Mohammed Al Hammad ◽  
Mohammed Ibrahim Aljikhlib ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Test Performance ◽  
Brain Injuries ◽  
Pediatric Patients ◽  
Functional Performance ◽  
Motor Score ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Gcs Score ◽  
Performance Results

There have been many limitations reported with using the Glasgow coma scale (GCS), including complexity, and being difficult to apply among aphasic, intubated, and pediatric patients. Accordingly, many researchers exerted serious efforts to enhance and modify the scale to make it more applicable and easy to interpret in these settings. The simplified motor score (SMS) was reported in the literature in 2012 for the assessment of patients with coma in different traumatic and non-traumatic settings. In the present study, we have discussed the findings of previous studies in the literature that compared the efficacy between the SMS and GCS in the assessment of patients with traumatic brain injuries within the emergency department and out-patient settings. Our results indicate the efficacy of the SMS is similar to that of the GCS score in predicting the different outcomes, including functional performance, need to perform tracheal intubation and hospital admission. Nevertheless, evidence regarding the prediction of mortality seems to be inconsistent across the different investigations. However, the differences between the two scores is not remarkable among these studies, indicating that the SMS is an efficacious tool in this regard within an acceptable test performance results. Furthermore, the SMS score can be easily applied within these without performing complex approaches, which makes it more advantageous than the GCS. However, this evidence is based on a limited number of investigations, and more studies are required.

scholarly journals Glasgow Coma Scale Motor Score and Pupillary Reaction To Predict Six-Month Mortality in Patients with Traumatic Brain Injury: Comparison of Field and Admission Assessment

2015 ◽  
Vol 32 (2) ◽  
pp. 101-108 ◽  
Author(s):  
Marek Majdan ◽  
Ewout W. Steyerberg ◽  
Daan Nieboer ◽  
Walter Mauritz ◽  
Martin Rusnak ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Motor Score ◽  
Coma Scale ◽  
Pupillary Reaction

Improving the Glasgow Coma Scale Score: Motor Score Alone Is a Better Predictor

2003 ◽  
Vol 54 (4) ◽  
pp. 671-680 ◽  
Author(s):  
C. Healey ◽  
Turner M. Osler ◽  
Frederick B. Rogers ◽  
Mark A. Healey ◽  
Laurent G. Glance ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Motor Score ◽  
Coma Scale

Naloxon – Medizinische Grundlagen und internationale Erfahrungen

2019 ◽  
Vol 65 (5) ◽  
pp. 335-342
Author(s):  
Norbert Wodarz ◽  
Jörg Wolstein ◽  
Heike Wodarz-von Essen ◽  
Oliver Pogarell
Keyword(s):  
Randomized Controlled Trial ◽  
Glasgow Coma Scale ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Coma Scale ◽  
International Standard ◽  
Trial Number ◽  
Randomized Controlled ◽  
Opioid Crisis ◽  
Lebensrettende Basismaßnahmen

Zusammenfassung. Hintergrund: Die Abhängigkeit von Opioiden ist mit erheblichen gesundheitlichen Gefährdungen der Betroffenen und einer hohen Mortalität assoziiert. Derzeit werden insbesondere die dramatisch gestiegenen Mortalitätsraten in den USA diskutiert (‚opioid crisis‘), aber auch in Deutschland war in den letzten Jahren ein kontinuierlicher Anstieg der Drogentoten, überwiegend verursacht durch Opioide, zu verzeichnen. Die Risiken einer Opioid Überdosierung bzw. Intoxikation resultiert vor allem aus der hemmenden Wirkung der Opioide auf den Atemantrieb, die durch andere gleichzeitig konsumierte Substanzen noch verstärkt werden kann. Neben Erstmaßnahmen (Notruf, lebensrettende Basismaßnahmen der Ersten Hilfe) kommt auch der Einsatz des Opioidantagonisten Naloxon in Betracht. Methode: Literaturrecherche in PubMed, Cochrane Library und im International Standard Randomized Controlled Trial Number (ISRCTN) Register. Ergebnisse: Auch aus ethischen Gründen liegen bislang eher wenig systematische Untersuchungen zum nicht-ärztlichen Einsatz von Naloxon bei Opioidüberdosierung vor. Trotzdem kann nach aktuellem Stand geschlussfolgert werden, dass die intranasale Verabreichung vergleichbar wirksam mit einer intramuskulären Anwendung zu sein scheint. Bei Überdosierten, die nach erfolgreichem Naloxon-Einsatz aus unterschiedlichen Gründen nicht in einer Klinik gebracht wurden, wurden in ca. 1 %. Todesfälle dokumentiert. Falls 60 min nach Naloxongabe unauffällige Vitalparameter und auf der Glasgow Coma Scale mind. 15 Punkte erreicht werden, besteht wohl ein sehr niedriges Rebound-Risiko. Im Vergleich dazu ist das Auftreten von Naloxon-induzierten Entzugssyndromen deutlich häufiger, hängen jedoch von der Dosis und dem konsumierten Opioid ab, wie auch von der verabreichten Naloxon-Dosis. Schlussfolgerungen: Naloxon kann mittlerweile auch in Deutschland als zugelassenes Nasalspray verabreicht werden und ist daher im Prinzip auch für den Einsatz durch Ersthelfer geeignet. Verbesserte Rahmenbedingungen, wie z. B. spezifische Schulungen könnten dazu beitragen, Take-Home Naloxon als erfolgreichen Baustein zur Reduktion von Drogentod zu implementieren.

Sign in / Sign up

Export Citation Format

Share Document