Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease

• Published in: Enfermeria intensiva Vol. 25; no. 1; p. 15
• Main Authors: Sánchez-Sánchez, M M, Sánchez-Izquierdo, R, Sánchez-Muñoz, E I, Martínez-Yegles, I, Fraile-Gamo, M P, Arias-Rivera, S
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.01.2014
• Subjects: Algorithms; Critical Care Nursing - statistics & numerical data; Critical Illness; Female; Glasgow Coma Scale - statistics & numerical data; Humans; Male; Middle Aged; Nervous System Diseases - diagnosis; Nervous System Diseases - surgery; Observer Variation; Prospective Studies; Reproducibility of Results; Escala del coma de Glasgow; Nursing; Neurological patients; Concordance; Glasgow coma scale; Concordancia; Enfermería; Paciente neurológico
• ISSN: 1578-1291
• DOI: 10.1016/j.enfi.2013.09.002

The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.