Mateen, Bilal A., Horton, Mike and Playford, E. Diane (2022) Psychometric analysis of the Glasgow Coma Scale and its sub-scale scores in a national retrospective cohort of patients with traumatic injuries. PLOS ONE, 17 (6). e0268527. doi:10.1371/journal.pone.0268527 ISSN 1932-6203.

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Abstract

Objectives: To determine the psychometric validity, using Rasch analysis, of summing the three constituent parts of the Glasgow Coma Scale (GCS). Design: National (registry-based) retrospective study. Setting: England and Wales. Patients: All individuals who sustained a traumatic injury and were: admitted for more than three days; required critical care resources; transferred for specialist management; or who died from their injuries. Main outcomes and measures: Demographic information (i.e., age at time of injury, and sex), item sub-scores of the first available GCS (either completed by the attending paramedics or on arrival to hospital), injury severity as denoted by the Injury Severity Scale (ISS), and outcome (survival to hospital discharge or 30-days post-injury, whichever is earliest). Results: 321,203 cases between 2008 and 2017. 55.9% were male, the median age was 62.7 years (IQR 44.2–80.8), the median ISS was 9 (IQR 9 to 17), and 6.6% were deceased at 30 days. The reliability statistics suggest that when the extreme scores (i.e. 3 and 15) are accounted for, that there is only sufficient consistency to support the separation of injuries into 3 broad categories, e.g. mild, moderate and severe. As extreme scores don’t impact Rasch item calibrations, subsequent analysis was restricted to the 48,417 non-extreme unique cases. Overall fit to the Rasch model was poor across all analyses (p < 0.0001). Through a combination of empirical evidence and clinical reasoning, item response categories were collapsed to provide a post-hoc scoring amendment. Whilst the modifications improved the function of the individual items, there is little evidence to support them meaningfully contributing to a total score that can be interpreted on an interval scale. Conclusion and relevance: The GCS does not perform in a psychometrically robust manner in a national retrospective cohort of individuals who have experienced a traumatic injury, even after post-hoc correction.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Journal or Publication Title:	PLOS ONE
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	8 June 2022
Dates:	Date Event 8 June 2022 Published 3 May 2022 Accepted
Volume:	17
Number:	6
Article Number:	e0268527
DOI:	10.1371/journal.pone.0268527
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	** From PLOS via Jisc Publications Router ** History: received 25-04-2021; collection 2022; accepted 03-05-2022; epub 08-06-2022. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	11 July 2022
Date of first compliant Open Access:	11 July 2022
Related URLs:	http://creativecommons.org/licenses/by/4...
Contributors:	Contribution Name Contributor ID UNSPECIFIED Christensen, Karl Bang UNSPECIFIED

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