2017 Volume 16 Issue 1 Pages 3-8
Objectives: In Japan, we often have been using the coma scales to inform the condition of patients quickly in emergency settings including prehospital care for traffic accident. Though the Japan Coma Scale (JCS) is mostly accepted domestically, it has some problems like disagreements among the raters. So, it is required to develop the new coma scale. In 2003, the Emergency Coma Scale (ECS) which solved these problems was developed and is becoming popular recently. To verify the resolution of the problem of the JCS, we designed the multi-center study named “ECS Co-Operative Multi center Evaluation Trial: E-COMET. Methods: We verified the validity of the ECS from two aspects: the agreement of the score among multiple raters (STEP Ⅰ) and accuracy of the evaluated score (STEP Ⅱ). In STEP I, Medical staffs in the ER evaluated the consciousness level of patients by ECS, JCS, and The glasgow scale (GCS). Then, we compared the weighted agreements among multiple raters by calculating the kappa coefficient. In STEP Ⅱ, medical students watched three videos of simulated patients with consciousness disturbance and evaluated the consciousness level using the three Coma Scales. From these data, we calculated the mean percentage of correct answers. Results: As a result, in STEP I, ECS showed higher agreements in whole raters. In STEP Ⅱ, the mean percentage of correct answers in all raters was significantly highest for the ECS. The results of 4th grade students who have no experience to evaluate by coma scales showed lowest accuracy at GCS which has complex way of evaluation. Conclusion: From both result, we thought that ECS might have enough simplicity to spread widely in not only multi-professionals but common citizen and be suitable for emergency settings.
