gms | German Medical Science

Objective: The Glasgow-Coma-Score is used for coding the level of consciousness at the site of accident, on admission, for prognosis, in clinical studies and in forensic controversies. Its sensitivity for depth of coma depends on the quality of coding the motoric answer.

Method: We interviewed 165 emergency doctors (in training and post training) about the guidelines for coding the motoric variable of the Glasgow-Coma-Score.

Results: Merely 14% gave the right answer according the guidelines: Code the "best motoric answer" of the “upper limb”. 86% coded the Glasgow-Coma-Score for the motoric variable false and inconsistently. However, the rate of right answers were higher in physicians in training (37,5%) than in finished and certified emergency doctors (5%). Emergency doctors post training stated in 68% that the variable should be coded according to the neurological results at the upper or lower extremity. Furthermore, they stated that the worst neurological result should be coded (43%).

Conclusions: Considering our data, the coding of the motoric variable has proofed to be done beside the guidelines and inconsistently. There are strong reasons to code the worst result. However, this procedure offends the guidelines presented by the literature. These guideline were never withdrawn. Emergency doctors code the motoric variable of the Glasgow-Coma-Score obviously with knowledge about the pathophysiology of traumatic brain injuries.