• Amado Alejandro Báez, Ediza M Giráldez, and Julio M De Peña.
• Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. aabaez@partners.org
• Prehosp Disaster Med. 2007 May 1;22(3):230-2.

IntroductionThe Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness in patients with head injuries. Rapid and accurate GCS scoring is essential for adequate assessment and treatment of critically sick and injured patients. This study sought out to determine the precision and reliability of the GCS among a cohort of Latin American Critical Care Transport Providers.MethodsThe study consisted of a cross-sectional design using an Internet-based examination. The evaluation consisted of four focused clinical scenarios with a classification based on severity. For measurement of intra-rater reliability the first and fourth cases were identical. Five minutes were allocated for each scenario. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations. For all tests, statistical significance was set at the 0.05 level.ResultsA total of 62 providers participated, including 17 physicians and 45 advanced providers (nurses and paramedics). No statistically significant differences were observed between physicians and advanced providers in the correct classification of the individual scenarios. Five of the 17 physicians (29.4%) answered all cases correctly, while none of the 45 advanced providers did (p < 0.001). When evaluating the duplicated cases (Cases 1 and 4), five physicians (29.4%) and 11 advanced providers (24.4%) correctly classified the cases. This difference was not statistically significant.ConclusionsThis study demonstrated a poor precision and poor reliability in the use of the Glasgow Coma Scale within the study subjects.

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