Advance Health Assessment
Instructions:-
In essay format, briefly describe your own patient population. With reference to validation literature, discuss the elements of reliability and validity of Glasgow Coma Scale. Where possible, select studies specific to your own patient population. Draw a conclusion about the usefulness of the assessment tool for your clinical practice. Your discussion should include a brief comparison of your chosen tool with alternative methods of assessment.
For this work it is permissible to include older literature as the original validation study may be the most comprehensive.
1. ensure there are at least three primary research articles that explore the reliability and or validity of your alternative tool).
Solution
Advance Health Assessment
Introduction
The Glasgow Coma Scale (GCS) was developed to provide a scoring system that describes the level of consciousness in individuals after a traumatic brain injury (Gill, Reiley, & Green, 2004). It aims at giving a reliable and objective way of coming up with the degree of consciousness of a person for initial as well as follow-up assessments. Any patient with a head injury is assessed against a scale and awarded points that range from 3 that indicates that the patient is severely unconscious and either 14 though new scales have 15 as the maximum points. The scale was mostly to assess the level of consciousness of patients with head injuries, but it now used regularly in health facilities for trauma patients. The paper will thus describe my patient population and also look at the elements of reliability and validity of Glasgow Coma Scale (GCS).
My patient population comprises of both a young and old generation of individuals who are supported by a working middle class. About half of this population identifies as a racial minority while 30 percent of the remaining population commercial insurance. The remaining patient uses a blend of Medicare, Medicaid and some are uninsured. Such a population can be described as vulnerable due to their lack of financial freedom. There is, therefore, need to increase the level of attention given to such a group of individuals to ensure that they reap the maximum benefits from the health care system. The health care system designed for such a population should be cheap and easily accessible. Local authorities should thus ensure that they address the needs of such a population when designing health care systems so as to ensure efficient delivery of health care, quality of measurement and modes of payment.
As stated earlier, the Glasgow Coma Scale (GCS) was developed to provide a structured way of assessing the level of consciousness in patients of head and brain traumas. The sum score derived from the assessment has been used extensively in research and the results adopted in the intensive care unit scoring systems. However, debate still exists on the reliability and validity of the Glasgow Coma Scale. The following review will thus seek to summarize evidence on the reliability of the GCS.
Research studies were undertaken in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data from the World Health Organization was used to identify possible ongoing trials. The study adopted observational studies aimed at assessing the reliability of the GCS as expressed by a statistical measure. These observation studies included cohort studies and case-control studies. The quality of the methodological quality was carefully evaluated with the consensus-based standards used in the selection of health measurement instruments (Reith, Van den Brande, Synnot, Gruen, & Maas, 2016). The researchers also synthesized different elements of reliability within the study.
The GSC was introduced primarily to assess the depth and duration of diminished consciousness. The scale used thus represents three aspects of behavioral responses that are the eye, motor, and verbal responses. The scale has a range of 15 points with four points for eye-opening, five for best verbal intervention and six for the best motor response. The researchers thus thought it wise to have a candid and practical assessment tool that’s usable in all hospitals. The tool also had to correctly reflect the ubiquitous dispersion of head injury victims.
The primary outcome of the study was to establish the reliability and validity of GCS. The safety aspects of the study measured included inter-observer reliability and the factors that affected such reliability. Efficacy outcomes aimed at finding out the correlation that exists between GCS and other indices that indicate impairments of brain function and also the correlation between GCS and other clinical events. The prognostic value outcomes measured mortality rates, survival rate neuropsychological tests, and functional recovery tests. Responsiveness tests sought to find out the correlation measures between changes in GCS and other outcome actions or changes on cerebral imaging (Glen, & Katy, 2011).
The researchers identified 57 significant studies that represented heterogeneity in the type of estimates used, patients observed and the characteristics of the observers. The qualities used to measure methodological quality include values such as good, fair and poor. For the high-quality studies, all interclass correlation coefficients indicated excellent reliability. Poor quality estimates of the study represented lower reliability estimates of the study. The researchers noted that reliability for most of the GCS components was higher than the sum scores. Amongst the factors suspected to affect the safety included one’s level of education and training, the level of consciousness and type of stimuli used.
In conclusion, only 16% of all the studies undertaken were of high quality, and a lot of inconsistency was realized throughout the survey. Despite the reliability being adequate in high-quality research, researchers recommended further improvements to the scale of measurements to improve the reliability of the study. The conclusion from the methodological perspective was to improve the reliability of studies while from a clinical viewpoint, the conclusion was that there be a renewed focus on training and standardization of the assessment process.
References
Gill, M. R., Reiley, D. G., & Green, S. M. (2004). Interrater reliability of Glasgow Coma Scale scores in the emergency department. Annals of emergency medicine, 43(2), 215-223.
Glen, G., & Katy, K. (2011). Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. The Lancet, 337(8740), 535-538.
Reith, F. C., Van den Brande, R., Synnot, A., Gruen, R., & Maas, A. I. (2016). The reliability of the Glasgow Coma Scale: a systematic review. Intensive care medicine, 42(1), 3-15.
