Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department

BACKGROUND: Altered mental status (AMS) comprises a group of clinical symptoms rather than a specific diagnosis. A variety of neurological scales have been used to monitor these patients, including the Glasgow coma scale (GCS), AVPU (alert, responds to verbal stimuli, responds to painful stimuli, unresponsive) scale, and ACDU (alert, confused, drowsy, unresponsive) scale. The simplified motor scale (SMS) has been found to be a potential replacement for the GCS. In this study, we compare the interrater reliability of the GCS (individual components), AVPU, ACDU, and SMS to patients presenting to the ED with AMS. MATERIALS AND METHODS: This was a prospective observational study conducted in the emergency department of an urban tertiary-care hospital in New Delhi, India. Patients with AMS (traumatic and nontraumatic) presenting to the ED were assessed by two emergency physicians within 10 minutes of each other using the four neurological scales. Percentage agreement and kappa coefficient score were used to determine interrater reliability for SMS, individual components of GCS, AVPU, and ACDU. RESULTS: The SMS had the best inter-rater percent agreement with 83.91% (95% CI 77.7–88.6%), followed by ACDU which was 76.44% (95% CI 69.0–81.6%), AVPU 75.29% (95% CI 67.8–80.6%), GCS Eye 74.14% (95% CI 66.6–79.6%), GCS Verbal 67.82% (95% CI 60.6–74.3%), and GCS Motor was 64.94% (95% CI 57.6–71.6%).The kappa coefficient for SMS was 0.75 (95% CI 0.67–0.83), followed by GCS Eye which was 0.63 (95% CI 0.54–0.72), AVPU 0.62 (95% CI 0.52–0.72), ACDU 0.60 (95% CI 0.49–0.71), and GCS Verbal 0.58 (0.49–0.66) and GCS Motor was 0.53 (95% CI 0.44–0.63). CONCLUSION: It can be said that SMS has the best interrater reliability in the ED and can be recommended for clinical use in the emergency departments for patients presenting with AMS. HOW TO CITE THIS ARTICLE: Haldar M, Verma A, Jaiswal S, Sheikh WR. Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department. Indian J Crit Care Med 2020;24(12):1198–1200.