Qatar’s Ambulance Paramedics’ evaluation of the conventional versus a revised Glasgow Coma Scale including a pupil score

Background

The Glasgow Coma Scale’s (GCS) use has evolved since it was first introduced and is now used to assess a broader range of patients.1 The GCS tool is commonly used by Qatar’s pre-hospital care professionals.2 Proposed changes include the subtraction of the Pupil Reaction Score and simpler assessment termonilogy.3 This is referred to as the GCS-P tool. This study aims to determine whether the changes result in increased ease-of-use and accuracy by qualified paramedics in comparison to the conventional GCS tool.

Methods

This quantitative study aimed to recruit a convenience sample of 297 Hamad Medical Corporation Ambulance Service (HMCAS) paramedics who were split into two groups (GCS and GCS-P), each with access to different online questionnaires with two identical brain injury scenario videos to assess (Traumatic Brain Injury (TBI) case and Pedestrian Vehicle Accident (PVA)). For the GCS-P group, an illustration depicting pupil reactivity to light was included. A Chi-square test was conducted to test whether each tested variable was independent between both groups.

Results

The conventional GCS and GCS-P questionnaires were respectively completed by 151 and 150 participants. The GCS group tended to report a score much closer to the expected result for both scenarios than the GCS-P group (Table 1). In Table 2, there is a statistically significant difference in variables 1 and 3 between both groups. Most GCS-P participants (85.6%) responded they would find it easier to directly calculate the pupil score with "0", "-1", and "-2" instead of determining it as a positive number and then subtracting it from the GCS score.

Conclusion

Based on the participants’ GCS scoring results, the GCS-P tool appeared to make participants’ over score the simulated patients’ level of consciousness. The chi-squared test results suggest that more training is needed to increase the familiarity in using the tool.