Fiabilidad interobservador de la escala del coma de Glasgow en pacientes críticos con enfermedad neurológica o neuroquirúrgica / Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease

INTRODUCCIÓN: La escala del coma de Glasgow (GCS) es un instrumento simple y habitual en la evaluación neurológica del paciente crítico. A pesar de su extendido uso, la GCS tiene algunas limitaciones pues, ocasionalmente, distintos observadores pueden valorar de forma diferente una misma respuesta. OBJETIVO: Evaluar la concordancia interobservador, entre enfermeras de intensivos con un mínimo de 3 años de experiencia, en la estimación global de la GCS y de cada uno de sus componentes. MÉTODO: Estudio observacional prospectivo, incluyendo a 110 pacientes neurológicos o neuroquirúrgicos, realizado en una unidad polivalente de 18 camas, desde octubre de 2010 hasta diciembre de 2012. Variables registradas: demográficas, motivo de ingreso, puntuación GCS global y de sus componentes. La valoración neurológica fue realizada por un mínimo de 3 enfermeras. Una aplicaba el algoritmo y la técnica de evaluación consensuada y todas, independientemente, valoraban la respuesta a los estímulos. Se mide la concordancia interobservador mediante el coeficiente de correlación intraclase (CCI) con intervalo de confianza (IC) del 95%. Este estudio fue aprobado por el Comité Ético de Ensayos Clínicos del hospital. RESULTADOS: El CCI (IC 95%) para la escala fue: GCS global: 0,989 (0,985-0,992); respuesta ocular: 0,981 (0,974-0,986); respuesta verbal: 0,971 (0,960-0,979); respuesta motora: 0,987 (0,982-0,991). CONCLUSIÓN: En nuestra cohorte de pacientes hemos observado un alto nivel de concordancia tanto en la aplicación de la GCS como en cada uno de sus componentes

INTRODUCTION: The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. OBJECTIVE: To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. METHODS: Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. RESULTS: The intraclass correlation coefficient (confident interval) for scale was: Overall GCS:0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.9600.979); motor response: 0.987 (0.982-0.991). CONCLUSION: In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components

[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease]. / Fiabilidad interobservador de la escala del coma de Glasgow en pacientes críticos con enfermedad neurológica o neuroquirúrgica.

INTRODUCTION: The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. OBJECTIVE: To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. METHODS: Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. RESULTS: The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). CONCLUSION: In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.