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중증 외상에서 Glasgow Coma Scale(GCS) 운동반응의 의의
신중호 ( Jung Ho Shin ),이성우 ( Sung Woo Lee ),정인철 ( In Chul Jung ),김수진 ( Su Jin Kim ),이베안 ( Be An Lee ),문성우 ( Sung Woo Moon ),정상헌 ( Sang Hun Jung ),김낙훈 ( Nak Hoon Kim ),최성혁 ( Sung Hyuk Choi ),홍윤식 ( Yun Si 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Background: Severely injured patients need an optimal triage system that can differentiate those patients who require the resources of the trauma center from those who do not. American national guidelines recommend that patients with Glasgow Coma Scale (GCS) scores less than 14 or triaged-Revised Trauma Score (t-RTS) less than 11 should be triaged to trauma centers. Although, in many studies, the GCS score has been shown to be the strongest single prognostic predictor in trauma patients, the presence of unmeasurable components of the GCS limits its usefulness. Also, it is difficult for emergency medical technicians to estimate the GCS in a prehospital setting because of its complexity and the shortage of time. This study was designed to evaluate the efficacy of the motor component of the GCS in severely injured patients. We hypothesized that the motor component of the GCS (GCSM) would be equally sensitive as the total GCS in triage of severely injuried patients. Methods: We reviewed a total of 114 patient who visited the Emergency Center of Korea University Ansan Hospital between December 2001 and September 2002. Of those 114 patients, 36 were excluded because of inadequate medical records or visiting after cardiac arrest. The parameters that we used as tools for analysi, were age, sex, GCS score, RTS, Injury Severity Score (ISS), actual survival rate (As), and probable survival rate (Ps). We defined severely injured patients (t-RTS ≤11) requiring care in a trauma center or intensive care unit. Based on American College of Surgeons Committee on Trauma (ACSCOT) guidelines, we defined GCS ≤13 as positive triage by GCS, ISS ≥16 as positive triage by ISS, and GCSM ≤5 as positive triage by the motor component of GCS. The sensitivity and the specificity were calculated, and a statistical analysis by t-test was conducted with two-tail α levels of 0.05. Results: Of the 78 patients, the mean age was 44.7±2.2,and the mean ISS was 21.7±1.0. The GCSM was found to have a sensitivity of 85.7% and a specificity of 98.0% for t-RTS≤11. The GCS had a sensitivity of 89.3% and a specificity of 90.0% (p = not significant). Conclusion: Our results indicate that the motor component of GCS is a sensitive predictor of patients` poor prognosis and that the GCSM is equivalent to the GCS for prehospital triage. In view of the simplicity of the GCSM, its substitution for the GCS in triage systems might lead to a higher use rate among prehospital healthcare providers.
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