The Accuracy of Glasgow Coma Score Documentation in a Trauma Database: Implications for Patient Care and Performance Metrics

Abstract

Abstract INTRODUCTION Quality measurement and performance metrics are becoming increasingly emphasized in health care. Recognizing the need for accurate and reliable data in quality measurement, practitioners and researchers moved away from administrative databases and towards registries. Our study looks to determine the accuracy of the GCS recorded in the trauma registry at our institution. METHODS Our hospital trauma registry was queried for all TBI patients from 2013 to 2017. GCS from the trauma registry (tGCS) was compared to the neurosurgery consult note (nGCS). Patients were excluded if there was no neurosurgery consult note or if the note was time-stamped more than 2 h from patient arrival. RESULTS There were 468 patients included in the final cohort. tGCS significantly differed from nGCS (6.6 vs 7.9, P < .001). There were 337 patients who would be considered severe TBI (tGCS = 8). Of these patients, the tGCS and nGCS also significantly differed (4.4 vs 6.3, P <.001). There were 188 (40.2%) patients with a tGCS of 3 and 89 (19.0%) with a nGCS of 3. The difference is statistically significant with a Fisher's Exact Test giving a P-value of < .001. There was a higher discrepancy between tGCS and nGCS in patients who survived in the entire cohort (1.61 vs 0.50, P < .001), the severe TBI patients (2.52 vs 0.61, P < .001) and the GCS 3 patients (4.08 vs 0.73, P < .001). Binomial regression modeling found that nGCS correlated with mortality more than tGCS or the highest GCS (hiGCS). CONCLUSION The GCS is meant to be an accurate, objective measure of a patient's mental status. However, significant disagreement when it is assessed by the trauma surgery team compared to the neurosurgery team. The difference is likely due to the time between assessments, as it allows for patient stabilization and reversal of pharmaceutical agents as patients who survived had a significantly larger change in GCS than those that died. Predictive modeling showed that the GCS recorded by the neurosurgery team is a better predictor of survival.