Simpler scale for predicting brain trauma outcomes

The Simplified Motor Score (SMS) can replace the Glasgow Coma Scale (GCS) for predicting outcomes of traumatic brain injury in the out-of-hospital setting, according to a new study.

Study commentary is even more emphatic, calling the GCS "obsolete within acute care medicine" and saying that it should be abandoned in the emergency department and out-of-hospital settings altogether in favor of newer, simpler methods of assessing trauma patients, such as the SMS.

The 13-point GCS is widely used as a screening tool for patients with and without traumatic brain injury, but it has been criticized for its complexity and poor interrater reliability. The 3-point SMS (obeys commands, localizes pain, and withdraws to pain or worse) was developed to overcome these limitations.

The investigators note that rapid, accurate, and reliable assessment of trauma patients is vital in out-of-hospital settings and that simplified methods of assessment, such as the SMS, could better determine appropriate triage and risk stratification.

Thompson DO, Hurtado TR, Liao MM, Byyny RL, Gravitz C, Haukoos JS. Validation of the Simplified Motor Score in the out-of-hospital setting for the prediction of outcomes after traumatic brain injury. Ann Emerg Med. 2011. doi:10.1016/j.annemergmed.2011.05.033.

Green SM. Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale. Ann Emerg Med. 2011. doi:10.1016/ j.annemergmed.2011.06.009.