The following is a summary of “Gestalt clinical severity score (GCSS) as a predictor of patient severity of illness or injury,” published in the April 2023 issue of Emergency Medicine by Shiber, et al.

For a study, researchers sought to determine if clinical judgment can accurately predict the severity of injury or illness in patients arriving by EMS to the emergency department or trauma center when other formal scoring systems are unavailable. 

The study was a multicenter pilot study that used a prospective observational convenience sample of 216 medical and trauma patients aged 18 and older transported by EMS (N = 216). Exclusion criteria included intubation, assisted ventilation, CPR in progress, prisoners, or previously present motor or speech deficits. A novel 15-point scale of Verbal, Motor, and Facial Expression was completed within 1-2 minutes of arrival by a clinician outside of the treatment team. The primary endpoint was the immediate disposition from the ED or Trauma Center, which included Home, Brief Observation (<24 h), Admission to the Floor, ICU (OR and IR as surrogates since these patients ultimately go to the ICU), or Morgue.

The results of the study showed a strong, positive monotonic correlation between the Glasgow Coma Scale Score (GCSS) and disposition (Rho = 0.693, P < .0001). The “best” model included GCSS and age (group 18–44 years old versus all the other age groups) (P< .0001). For a one-unit increase in GCSS (OR = 2.56, 95% CI 1.94, 3.37), there was a 156% increase in the odds of being discharged home (versus being admitted).

In conclusion, the study suggested that physicians can accurately predict the severity of injury and illness using a gestalt method and the scoring system developed in the study. The GCSS is most accurate with the 18-44 age group. The finding has important implications for patient triage and management in emergency departments and trauma centers.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723000086