Is AVPU comparable to GCS in critical prehospital decisions? - A cross-sectional study.

Autor: Janagama SR; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: srinu.j.rao@gmail.com., Newberry JA; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA., Kohn MA; Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA., Rao GVR; Emergency Medicine Learning Centre and Research, GVK Emergency Management Research Institute, Secunderabad, Telangana, India., Strehlow MC; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA., Mahadevan SV; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2022 Sep; Vol. 59, pp. 106-110. Date of Electronic Publication: 2022 Jun 26.
DOI: 10.1016/j.ajem.2022.06.042
Abstrakt: Background: Advanced Trauma Life Support field triage utilizes the Glasgow Coma Scale (GCS) to assess the level of consciousness. However, prehospital care providers in low- and middle-income countries (LMICs) often use the Alert, Verbal, Pain, and Unresponsive (AVPU) scale to assess the level of consciousness. This study aimed to determine whether prehospital AVPU categorization correlates with mortality rates in trauma victims, similarly to GCS.
Methods: In this cross-sectional study conducted between November 2015 and January 2016, we enrolled a convenience sample of prehospital trauma-related field activations. The primary outcome measure was the probability of death within 48 h for each category of AVPU.
Results: In a convenience sample of 4514 activations, 1606 (35.6%) met exclusion criteria, four did not have AVPU, and four did not have GCS, leaving 2900 (64.2%) trauma activations with both AVPU and GCS available for analysis. Forty-eight-hour follow-up data were available for 2184 (75.3%) activations out of these 2900. The 48-h mortality rates for each category of AVPU were 1.1% (Alert), 4.3% (Verbal), 17.9% (Pain), 53.2% (Unresponsive); and, for each GCS-based injury severity category, they were 0.9% (Mild, GCS 13-15), 8.1% (Moderate, GCS 9-12), 43.5% (Severe, GCS ≤ 8). Overall, there was a statistically significant difference in GCS for each category of AVPU (p < 0.001) except between patients responding to verbal commands and those responding to pain (p = 0.18). The discriminative ability of AVPU (AUC 79.7% (95% CI 73.4-86.1)) and GCS (AUC 81.5% (95% CI 74.8-88.2)) for death within 48-h following hospital drop-off were comparable.
Conclusion: EMT assessments of AVPU and GCS relate to each other, and AVPU predicts mortality at 48 h. Future studies using AVPU to assess the level of consciousness in prehospital trauma protocols may simplify their global application without impacting the overall quality of care.
Competing Interests: Declaration of Competing Interest SAM, SRJ, MCS, MAK, and JAN do not have any conflict of interest to disclose. GVR is a full-time employee of the GVK Emergency Management Research Institute, which operates the ambulance services studied here.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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