Simplified Motor Score

[EMT B]

Here is a post about it

The bottom line of his post: "Bottom line: The simplified motor score is a simple system that has now been shown to be as accurate as GCS in predicting severity and outcome from head injury. To be clear, though, neither is a perfect system. They must still be combined with clinical and radiographic assessments to achieve the best accuracy. But SMS can and should be used both in-hospital and prehospital to get a quick assessment, and may help determine early intervention and need for activating the trauma team."


Anybody heard of or using the Simplified Motor Score?

 

[Christopher]

Here is a post about it

The bottom line of his post: "Bottom line: The simplified motor score is a simple system that has now been shown to be as accurate as GCS in predicting severity and outcome from head injury. To be clear, though, neither is a perfect system. They must still be combined with clinical and radiographic assessments to achieve the best accuracy. But SMS can and should be used both in-hospital and prehospital to get a quick assessment, and may help determine early intervention and need for activating the trauma team."


Anybody heard of or using the Simplified Motor Score?

First I've heard of it, but man does it look easy. Easy means more likely to be done every time, and done more accurately. It also conveys a bit more information in that you only have one measure rather than a composite score.

It appears EMS agencies in Ohio have used the Simplified Motor Score:

CONCLUSIONS:
In a state trauma registry including both trauma and non-trauma centres, the EMS-obtained SMS performs as well as the 15-point GCS.

There have been a handful of studies comparing the SMS to GCS, and all are favorable, but none conclusive.

1. Singh B, et al. Meta-analysis of Glasgow coma scale and simplified motor score in predicting traumatic brain injury outcomes. Brain Inj. 2013;27(3):293-300.
2. Gill M, et al. A comparison of five simplified scales to the out-of-hospital Glasgow Coma Scale for the prediction of traumatic brain injury outcomes. Acad Emerg Med. 2006 Sep;13(9):968-73. Epub 2006 Aug 7.

 

[Bullets]

I dont see how this provides any benefit over the GCS.

If you are doing a decent assessment, you will cover all the points of the GCS. I dont see a need to 'simplify' this any more than it already is.

 

[chaz90]

I dont see how this provides any benefit over the GCS.

If you are doing a decent assessment, you will cover all the points of the GCS. I dont see a need to 'simplify' this any more than it already is.

Except that we (EMS as a whole) have shown that we're pretty awful at coming up with an accurate GCS score. You wouldn't think it would be difficult, but those pesky numbers between 3 and 15 seem to give us problems. Try it on your next call. Come up with a score on a patient, then independently ask a couple other providers with you what GCS score they saw. You may be surprised by the results.

 

[unleashedfury]

Except that we (EMS as a whole) have shown that we're pretty awful at coming up with an accurate GCS score. You wouldn't think it would be difficult, but those pesky numbers between 3 and 15 seem to give us problems. Try it on your next call. Come up with a score on a patient, then independently ask a couple other providers with you what GCS score they saw. You may be surprised by the results.

I agree and I don't agree. generally speaking the big numbers to worry about are 3, 8 and 15.

3 they are obviously unconscious 8 being critical and 15. being awake oriented and obeys commands.

So if we run a call together for lets say a vehicle accident and the patient has abused a substance. Eyes may be spontaneous 4, Verbal may be inappropriate 4 but obeys commands so he gets a score of 14. however considering the circumstances that being inebriated can cause a altered score you may say its normal for a patient in the circumstances so call it a 15. or say his verbal is confused so you give him a score of 3. dropping it to a 13.

to me its like any other tool its got its critical points and its got its flaws. for the most part its a matter of discussion when you transfer for the continuum of care I have had docs ask what my GCS score was on the initial assessment and tell them and they give me their score usually we are within a number or so.

 

[Christopher]

I agree and I don't agree. generally speaking the big numbers to worry about are 3, 8 and 15.

"Less than 8, intubate" is a tired mantra of an outdated era. It ranks up there with intracardiac epinephrine and should be promptly forgotten.

3 they are obviously unconscious 8 being critical and 15. being awake oriented and obeys commands.

Those numbers don't always correlate well with outcome or severity in actuality. Intrarater reliability is a big problem with GCS (also real time evaluation versus retrospective evaluation).

to me its like any other tool its got its critical points and its got its flaws. for the most part its a matter of discussion when you transfer for the continuum of care I have had docs ask what my GCS score was on the initial assessment and tell them and they give me their score usually we are within a number or so.

Most studies of GCS and EMS have been equivocal at best.

 

[Bullets]

Our charting system has you fill out GCS in the initial Neuro assessment and each time you enter vitals, so i am pretty familiar with it