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Field Triage of Trauma Patients Based upon the Ability to Follow Commands: A Study in 29,573 Injured Patients

Meredith, Wayne MD; Rutledge, Robert MD; Hansen, Alfred R. MD; Oller, Dale W. MD; Thomason, Michael MD; Cunningham, Paul MD; Baker, Christopher C. MD

Journal of Trauma-Injury Infection & Critical Care:
Article
Abstract

If a trauma system is to deliver ``the right patient to the right hospital at the right time,'' a simple triage tool that can be used in the field to rapidly identify patients with a significant risk of morbidity and mortality is vital.

Objective: The purpose of this study was to evaluate the effectiveness of the Glasgow Coma Scale's Motor Response Component (GMR) in identifying such patients.

Methods: From patient records in a well established state trauma registry, the predictive power of the Glasgow Motor Score was compared with the predictive power of the Injury Severity Score (ISS), Trauma Score, and whole Glasgow Coma Scale score (GCS), using discriminant analysis and logistic regression.

Results: Complete data were available for analysis for 29,573 patients. Nine percent died. The analyses demonstrated that the GMR was almost as good as the TS and better than the other scores in identifying patients at risk of dying. The highest discriminant accuracy was obtained by predicting that patients with a GMR of 6 would live and that all others (GMR 1-5) were at risk of dying. This means separating patients according to whether or not they follow simple commands.

Conclusions: The study demonstrated the GMR to be a good predictor of mortality in injured patients. Patients at risk of dying can best be identified by separating patients into those who cannot follow simple commands (GMR 1-5) from all others. This rapid and simple assessment could be useful as a prehospital tool to identify patients at risk of dying. First responders and nonmedical personnel not skilled in the use of the Trauma Score can easily determine if victims are able to follow commands and potentially identify the patients who are likely to require urgent trauma center care.

Author Information

From the Bowman Gray School of Medicine (W.M.), University of North Carolina School of Medicine (R.R., C.C.B.), University of North Carolina Hospitals (A.R.H.), Wake Medical Center (D.W.O.), Carolinas Medical Center (M.T.), and the University Medical Center for Eastern Carolina (P.C.). The authors are members of the North Carolina Trauma Registry.

Address for reprints: Wayne Meredith, MD, Dept. of Surgery, Bowman Gray School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157.

© Williams & Wilkins 1995. All Rights Reserved.