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A Prospective Evaluation of the Impact of Initial Glasgow Coma Score on Prehospital Treatment and Transport of Seizure Patients

Published online by Cambridge University Press:  28 June 2012

Daniel W. Spaite ,
Terence D. Valenzuela ,
Harvey W. Meislin ,
Elizabeth A. Criss  and
John Ross
Daniel W. Spaite*
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Az.
Terence D. Valenzuela
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Az. Tucson Fire Department, Tucson, Az.
Harvey W. Meislin
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Az.
Elizabeth A. Criss
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Az.
John Ross
Affiliation:
Tucson Fire Department, Tucson, Az.
*
Section of Emergency Medicine, University of Arizona, 1501 N. Campbell, Tucson, AZ 85724USA
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Abstract

Hypothesis:

The initial Glasgow Coma Score (GCS) obtained by prehospital personnel on seizure victims is associated with the likelihood of treatment and transport.

Methods:

Prehospital data were collected prospectively for all patients presenting with seizures to a mid-sized emergency medical services system during a five-month period. A total of 419 cases occurred (62.8% male, 37.2% female). Seizure frequency was highest in infants under the age of three years and in adults in their late 20s. A GCS was recorded in 378 cases (90.2%, study group). The GCS was >10 in 304 patients (80.4%) and ≤10 in 74 (19.6%). Patients with GCS≤10 were more likely to receive: oxygen (50.0% vs. 20.1%, p<.0001); IV (35.1% vs. 8.9%, p<.0001); intravenous (IV) medications (16.2% vs. 1.0%, p<.0001); and transport (97.3% vs. 76.3%, p<.0001).

Conclusion:

Seizure patients with a GCS of ≤10 were more likely to receive a variety of prehospital treatments and to be transported than were patients with GCS >10. However, the clinical indicators that were used to make the decision that it was “safe” not to transport nearly one-third of the patients are unclear. Essentially no data exist regarding the parameters impacting treatment and transport of seizure patients. Future investigations with outcome data, are needed to determine whether low risk criteria can be developed to identify those patients (if any) that do not require treatment or transport. A GCS may provide an objective, reproducible parameter upon which to begin formulating such criteria.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 2 , June 1992 , pp. 127 - 132
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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References

1. Cohen, HC: Assessment of the EMT-P medications used by Baltimore county fire department EMS supervisors/EMT-Ps. Prehospital and Disaster Medicine 1990;5:19–23.CrossRefGoogle Scholar
2. Paris, PM: Editorial response to Cohen HC: Assessment of the EMT-P medications used by Baltimore county fire department EMS supervisors/EMT-Ps. Prehospital and Disaster Medicine 1990;5:24.CrossRefGoogle Scholar
3. Epilepsy Foundation of America: Seizure Recognition and First Aid. Epilepsy Foundation of America, 1988.Google Scholar
4. Baraff, LJ, Schriger, DL, Starkman, S: Compliance with a standard for the emergency department management of epileptics who present after an uncomplicated convulsion. Ann Emerg Med 1990;19:367–372.CrossRefGoogle ScholarPubMed
5. Malouf, R, Brust, JCM: Hypoglycemia: Causes, neurological manifestations, and outcome. Ann Neural 1985;17:421–430.CrossRefGoogle ScholarPubMed
6. Messing, R, Simon, R: Seizures as a manifestation of systemic disease. Neurologic Clinics 1986;4:563–575.CrossRefGoogle ScholarPubMed
7. Venna, N, Sabin, TD: Tonic focal seizures in nonketotic hyperglycemia of diabetes mellitus. Arch Neurol 1981;38:512–514.CrossRefGoogle ScholarPubMed
8. Rich, JA, Singer, DE: Cocaine-related symptoms in patients presenting to an urban emergency department. Ann Emerg Med 1991;20:616–621.CrossRefGoogle Scholar
9. Orlowski, JP, Paganini, EP, Pippenger, CE: Treatment of a potentially lethal dose isoniazid ingestion. Ann Emerg Med 1988;17:73–76.CrossRefGoogle ScholarPubMed
10. Kulig, K, Rumack, BH, Sullivan, JB et al. : Amoxipine overdose: Coma and seizures without cardiotoxic effects. JAMA 1982;248:1092–1094.CrossRefGoogle Scholar
11. Singer, EP, Kolischenko, A: Seizures due to theophylline overdose. Chest 1985;87:755–757.CrossRefGoogle ScholarPubMed
12. Young, GP, Rores, C, Murphy, C et al. : Intravenous phenobarbital for alcohol withdrawal and convulsions. Ann Emerg Med 1987;16:847–850.CrossRefGoogle ScholarPubMed
13. National Fire Protection Association: Uniform Fire Incident Reporting System (VFIRS) Coding Manual. Boston, NFPA, Vol. 4, 1977.Google Scholar
14. Valenzuela, TD, Keeley, KT, Criss, EA et al. : Implementation of a computerized management information system in an urban fire department. Ann Emerg Med 1989;18:573–578.CrossRefGoogle Scholar
15. Spaite, DW, Hanlon, T, Criss, EA et al. : Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool. Ann Emerg Med 1990;19:1270–1273.CrossRefGoogle ScholarPubMed
16. Teasdale, G, Jennett, B: Assessment of coma and impaired consciousness: A practical scale. Lancet 1974;2:81–84.CrossRefGoogle ScholarPubMed
17. Rademaker, AW, Powell, DG, Read, JH: Inappropriate use and unmet need in paramedic and non-paramedic ambulance systems. Ann Emerg Med 1987;16:553–556.CrossRefGoogle Scholar
18. Santer, LJ, Yamashita, TS, Krug, SE: Inappropriate use and unmet need in emergency Medical services for children. Ann Emerg Med 1990;19:483. Abstract.Google Scholar
19. Gibson, G: Measures of emergency ambulance effectiveness: Unmet need and inappropriate use. Ann Emerg Med 1977;6:389–392.Google ScholarPubMed
20. Champion, HR, Sacco, WJ, Carnazzo, AJ et al. : Trauma score. Crit Care Med 1981;9:672–676.CrossRefGoogle ScholarPubMed
21. Morris, JA, Auerbach, PS, Marshall, GA et al. : The trauma score as a triage tool in the prehospital setting. JAMA 1986;256:1319–1325.CrossRefGoogle ScholarPubMed
22. Hoffman, JR, Luo, J, Schriger, DL et al. : Does paramedic base hospital contact result in beneficial deviations from standard prehospital protocols? West J Med 1990;153:283–287.Google ScholarPubMed
23. Neely, KW, Norton, R, Bartkus, E et al. : The effect of base station contact on ambulance destination. Ann Emerg Med 1990;19:906–909.CrossRefGoogle ScholarPubMed
24. Hedges, JR, Heiser, JM, Neely, KW et al. : Analysis of base station morphine orders: Assessment of supervising physician consistency. J Emerg Med 1990;8:587–590.CrossRefGoogle ScholarPubMed
25. Spaite, DW, Criss, EA, Valenzuela, TD et al. : A prospective evaluation of prehospital patient assessment by direct infield observation: Failure of ALS personnel to measure vital signs. Prehospital and Disaster Medicine 1990;5:325–334.CrossRefGoogle Scholar
26. Thompson, SJ, Schriver, J: A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon. J Emerg Med 1984;1:421–428.CrossRefGoogle ScholarPubMed
27. Rottman, SJ, Fitzgerald-Westby, K: A method for reviewing radio-telemetry paramedic calls. Ann Emerg Med 1981;10:36–38.CrossRefGoogle ScholarPubMed
28. Pozen, MW, D'Agostino, RB, Sytkowski, PA et al. : Effectiveness of a prehospital medical control system: An analysis of the interaction between emergency room physician and paramedic. Circulation 1981;63:442–447.CrossRefGoogle ScholarPubMed
29. Pointer, JE: The effect of standing orders on medication and skill selection, paramedic assessment, and hospital outcome: A follow-up report. Prehospital and Disaster Medicine 1989;4:62. Abstract.Google Scholar
30. Spaite, DW, Joseph, M: Prehospital cricothyrotomy: An investigation of indications, technique, complications and patient outcome. Ann Emerg Med 1990;19:279–285.CrossRefGoogle ScholarPubMed
31. Erder, MH, Davidson, SJ, Cheney, RA: On-line medical command in theory and practice. Ann Emerg Med 1989;18:261–268.CrossRefGoogle ScholarPubMed
32. Pointer, JE, Osur, MA: Effect of standing orders on field times. Ann Emerg Med 1989;18:1119–1121.CrossRefGoogle ScholarPubMed
33. Wasserberger, J, Ordog, GJ, Donoghue, G et al. : Base station prehospital care: Judgment errors and deviations from protocol. Ann Emerg Med 1987;16:867–871.CrossRefGoogle ScholarPubMed