A Sacred Cow Slaughtered: Eliminating the Glasgow Coma Scale from Trauma Field Triage

A large two-center validation study provides good evidence that “patient does not follow commands” is just as predictive as the more-complex Glasgow Coma Scale.

A signature contribution of modern prehospital care has been to regionalize trauma care. Under regionalization, severely injured patients are not transported to the nearest hospital — instead, they go to the region's designated trauma center (they are “up-triaged”). But how do prehospital personnel decide? They use the CDC's Guidelines for Field Triage of Injured Patients. These guidelines direct prehospital personnel to up-triage when a patient has a Glasgow Coma Scale (GCS) score of <14 or meets one of the other numerous criteria for up-triage.

Because the GCS is a hassle for paramedics to learn and calculate, investigators have proposed using instead a simpler triage tool: if an injured person is not following commands, up-triage. Now inv…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

A Sacred Cow Slaughtered: Eliminating the Glasgow Coma Scale from Trauma Field Triage

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Reviewing Author