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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, un...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Jaypee Brothers Medical Publishers
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775939/ https://www.ncbi.nlm.nih.gov/pubmed/33446972 http://dx.doi.org/10.5005/jp-journals-10071-23603 |
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author | Haldar, Meghna Verma, Ankur Jaiswal, Sanjay Sheikh, Wasil R |
author_facet | Haldar, Meghna Verma, Ankur Jaiswal, Sanjay Sheikh, Wasil R |
author_sort | Haldar, Meghna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7775939 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Jaypee Brothers Medical Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-77759392021-01-13 Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department Haldar, Meghna Verma, Ankur Jaiswal, Sanjay Sheikh, Wasil R Indian J Crit Care Med Original Article 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. Jaypee Brothers Medical Publishers 2020-12 /pmc/articles/PMC7775939/ /pubmed/33446972 http://dx.doi.org/10.5005/jp-journals-10071-23603 Text en Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd. © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Article Haldar, Meghna Verma, Ankur Jaiswal, Sanjay Sheikh, Wasil R Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title | Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title_full | Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title_fullStr | Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title_full_unstemmed | Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title_short | Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department |
title_sort | interrater reliability of four neurological scales for patients presenting to the emergency department |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775939/ https://www.ncbi.nlm.nih.gov/pubmed/33446972 http://dx.doi.org/10.5005/jp-journals-10071-23603 |
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