Evaluation of the Effectiveness of Glasgow Coma Scale and Parameters in the Decision Phase of Rapid Sequence Intubation in Altered Mental Status Developing During the Emergency Room Follow-up of Non-Traumatic Patients

Osman Sezer Çınaroğlu; Adnan Yamanoğlu; Umut Payza; Ahmet Kayalı; Hüseyin Acar; Rezan Karaali; Fatih Topal

doi:10.7197/cmj.946402

EN

Evaluation of the Effectiveness of Glasgow Coma Scale and Parameters in the Decision Phase of Rapid Sequence Intubation in Altered Mental Status Developing During the Emergency Room Follow-up of Non-Traumatic Patients

Abstract

Abstract: Glasgow coma scale (GCS) is one of the most important parameters in deciding rapid sequential intubation (RSI) in emergency department (ED). The aim of this study is to determine the effectiveness of the GCS and each of its parameters in making RSI decisions in non-traumatic patients brought to the ED.

Methods: This prospective observational study was conducted in an ED of a tertiary training and research hospital, which accepts approximately 250.000 patients annually. The value of GCS and GCS parameters in deciding to intubation in patients with an RSI indication was compared with the Pearson χ2 test. Multivariate logistic regression analysis was used for assessment of combinations of GCS parameters.

Results: A total of 276 patients were included in the study. It was found that the mortality rates was statistically significantly higher in the cases with GCS 4-10 (including) in the combinations with the low motor response. Motor scoring was more statistically significant for mortality in the evaluation made by creating 120 combinations between the remaining 4-14 GCS scores after the 3 and 15 GCS scores of the cases were removed from the GCS scores.

Conclusion: It was found that the motor response showed more linear progress compared to the verbal response and eye response evaluation, and the other parameters were not linear in the evaluation between the GCS total score and GCS combinations of the cases. Motor response was determinant in the total GCS score.

Keywords

References

Referans1. Mahler ME. Neurological emergencies. Yoshikawa TT, Norman DC, eds. Acute Emergencies and Critical Care of the Geriatric Patient. 1nci baskı. New York: Marcel Dekker Inc., 2000:369-83.
Referans2.Fitch MT. Altered Mental Status in the Elderly: Neurologic Nightmares. Presentation at Boston Scientific Assembly, October 2009, www.acep.org/workarea/downloadasset.aspx?id=46370.
Referans3. T Bein, K Taeger. Score systems in emergency medicine. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993 Jun; 28 (4):222-7. doi: 10.1055/s-2007-998911.
Referans4. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13:818–826.
Referans5. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13; 2(7872):81-4.
Referans6. C. Healey, Turner M. Osler, Frederick B. Rogers et al. Improving the Glasgow Coma Scale Score: Motor Score Alone Is a Better Predictor. The Journal of Trauma Injury, Infection, and Critical Care. Vol54 Nbr 4 Doi: 10.1097 /01. TA. 0000058130. 30490.5D
Referans7. Florence C.M. Reith, Hester F. Lingsma, Belinda J.Gabbe et all.Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54 069 patients with traumatic brain injury.Injury, Int. J. Care Injured S0020-1383(17)30363-7
Referans8. Prasad K, Menon GR. Comparison of the three strategies of verbal scoring of the Glasgow Coma Scale in patients with stroke. Cerebrovascular Diseases 1998; 8:79– 85.

Referans9. Nastaran Eizadi Mood, Ali Mohammad Sabzghabaee, Zahra Khalili-Dehkordi Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma clinical investigation 2011/55/6 p: 599-604.
Referans10. ACS AC of S. ATLS Advanced Trauma Life Support 10th Edition Student Course Manual. 10th ed. American College of Surgeons; 2018.
Referans11. Decreased Glasgow Coma Scale Score Does Not Mandate Endotracheal Intubation in the Emergency Department March 2009 Journal of Emergency Medicine 37(4):451-5 DOI: 10.1016/j.jemermed.2008.11.026
Referans12. B Jennett, G Teasdale. Aspects of coma after severe head injury. Lancet. 1977 Apr 23; 1(8017):878-81. doi: 10.1016/s0140-6736(77)91201-6.
Referans13. Mehdi Moazzez Lesko, Tom Jenks, Sara J O'Brien, Charmaine Childs, Omar Bouamra, Maralyn Woodford, Fiona Lecky. Comparing Model Performance for Survival Prediction Using Total Glasgow Coma Scale and Its Components in Traumatic Brain Injury. J Neurotrauma. 2013 Jan 1; 30 (1):17-22.
Referans14. Megan Maserati, Anita Fetzick, Ava Puccio. The Glasgow Coma Scale (GCS): Deciphering the Motor Component of the GCS. J Neurosci Nurs. 2016 Dec; 48 (6):311-314. doi: 10.1097/JNN.0000000000000242.
Referans15. Al-Salamah MA, McDowell I, Stiell IG, Wells GA, Perry J, Al-Sultan M, et al. Initial emergency department trauma scores from the OPALS study: the case for the motor score in blunt trauma. Acad Emerg Med 2004; 11: 834–42.
Referans16. Nik A, Sheikh Andalibi MS, Ehsaei MR et al. The Efficacy of Glasgow Coma Scale (GCS) Score and Acute Physiology and Chronic Health Evaluation (APACHE) II for Predicting Hospital Mortality of ICU Patients with Acute Traumatic Brain Injury. Bull Emerg Trauma. 2018;6 (2):141-145. doi: 10.29252/beat-060208.
Referans17. Irfan Ucgun, Muzaffer Metintas, Hale Moral et al. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respiratory Medicine (2006) 100, 66–74
Referans18. J J P Buitendag, A Ras, V Y Kong et al. Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa S Afr Med J. 2018 Feb 1;108(2):90-93. doi: 10.7196/SAMJ.2017.v108i2.12757.
Referans19. RL Sacco, R VanGool, JP Mohr, WA Hauser. Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome. Arch Neurol. 1990 Nov; 47(11):1181-4. doi: 10.1001 / archneur. 1990. 00530110035013

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Osman Sezer Çınaroğlu
0000-0002-3860-2053
Türkiye

Adnan Yamanoğlu ^*
0000-0003-3464-0172
Türkiye

Umut Payza
0000-0002-5297-1066
Türkiye

Ahmet Kayalı
0000-0003-2557-0600
Türkiye

Hüseyin Acar
0000-0002-1905-7133
Türkiye

Rezan Karaali
0000-0003-1831-2566
Türkiye

Fatih Topal
0000-0002-9941-4224
Türkiye

Publication Date

June 30, 2022

Submission Date

June 1, 2021

Acceptance Date

June 12, 2022

Published in Issue

Year 2022 Volume: 44 Number: 2

DOI

https://doi.org/10.7197/cmj.946402

IZ

https://izlik.org/JA23RC95DT

Cite

RIS / Bibtex

AMA

1.Sezer Çınaroğlu O, Yamanoğlu A, Payza U, et al. Evaluation of the Effectiveness of Glasgow Coma Scale and Parameters in the Decision Phase of Rapid Sequence Intubation in Altered Mental Status Developing During the Emergency Room Follow-up of Non-Traumatic Patients. CMJ. 2022;44(2):204-210. doi:10.7197/cmj.946402

Öz

Evaluation of the Effectiveness of Glasgow Coma Scale and Parameters in the Decision Phase of Rapid Sequence Intubation in Altered Mental Status Developing During the Emergency Room Follow-up of Non-Traumatic Patients

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite