Comparative Effectiveness Review Number 182 Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review e Comparative Effectiveness Review Number 182 Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00009-I Prepared by: Pacific Northwest Evidence-based Practice Center Portland, OR Investigators: Roger Chou, M.D. Annette M. Totten, Ph.D. Miranda Pappas, M.A. Nancy Carney, Ph.D. Spencer Dandy, B.S. Sara Grusing, B.A. Rongwei Fu, Ph.D. Ngoc Wasson, M.P.H. Craig Newgard, M.D., M.P.H., FACEP AHRQ Publication No. 16(17)-EHC041-EF January 2017 This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. Suggested citation: Chou R, Totten AM, Pappas M, Carney N, Dandy S, Grusing S, Fu R, Wasson N, Newgard C. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review. Comparative Effectiveness Review No.182. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No.16(17)-EHC041- EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The National Highway Traffic Safety Administration (NHTSA) requested and provided funding for this report. The reports and assessments provide organizations with comprehensive, evidence-based information on common medical conditions and new health care technologies and strategies. They also identify research gaps in the selected scientific area, identify methodological and scientific weaknesses, suggest research needs, and move the field forward through an unbiased, evidence-based assessment of the available literature. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review and public comment prior to their release as a final report. AHRQ expects that the EPC evidence reports and technology assessments, when appropriate, will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. If you have comments on this evidence report, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to [email protected]. Andrew Bindman, M.D. Arlene S. Bierman, M.D., M.S. Director Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. David W. Niebuhr, M.D., M.P.H., M.Sc. Director Task Order Officer Evidence-based Practice Center Program Center for Evidence and Practice Improvement Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Cathy Gotschall, Sc.D. Senior Health Scientist National Highway Traffic Safety Administration U.S. Department of Transportation iii Acknowledgments The authors acknowledge Andrew Hamilton, M.L.S., M.S., for conducting literature searches, and Leah Williams, B.S., for providing editorial assistance. Both are located at the Oregon Health & Science University. Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who provided input to this report follows: Eileen Metzger Bulger, M.D., FACS* E. Brooke Lerner, Ph.D.* Professor Professor With Tenure Department of Surgery Departments of Emergency Medicine and University of Washington Pediatrics Chief of Trauma, Harborview Medical Care Medical College of Wisconsin Seattle, WA Milwaukee, WI Steven M. Green, M.D., FACEP* N. Clay Mann, Ph.D., M.S.* Professor Professor Emergency Medicine and Pediatrics Department of Pediatrics Loma Linda University Medical Center and University of Utah School of Medicine Children’s Hospital Salt Lake City, UT Loma Linda, CA P. Daniel Patterson, Ph.D., M.P.H., M.S., Julie C. Leonard, M.D., M.P.H.* N.R.P.* Associate Professor Adjunct Assistant Professor Department of Pediatrics Department of Emergency Medicine Division of Emergency Medicine University of Pittsburgh The Ohio State University College of Medicine Pittsburgh, PA Columbus, OH iv Scott M. Sasser, M.D.* David W. Wright, M.D., FACEP Professor Associate Professor With Tenure Department of Emergency Medicine Department of Emergency Medicine University of South Carolina School of Emory University Medicine Atlanta, GA Columbia, SC *Provided input on Draft Report Peer Reviewers Prior to publication of the final evidence report, the EPC sought input from independent Peer Reviewers without financial conflicts of interest. However, the conclusions and synthesis of the scientific literature presented in this report do not necessarily represent the views of individual reviewers. Peer Reviewers must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential nonfinancial conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential nonfinancial conflicts of interest identified. The list of Peer Reviewers follows: Blair Bigham, M.D., M.Sc., ACP Mark Gestring, M.D., FACS Paramedic and EMS Researcher