Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes After Traumatic Brain Injury

Journal Club Summarymotor score
Methodology score: 3/5
Usefulness score: 2/5

Thompson DO, Hurtado TR, Liao MM, Byyny RL, Gravitz C, Haukoos JS.
Ann Emerg Med. 2011 Nov;58(5):417-25
 
This retrospective registry study demonstrated poor performance of either the Simplified Motor Score or GCS scores for predicting clinically important outcomes after traumatic brain injury when calculated by prehospital providers.  Journal Club attendees expressed reservations about the large proportion of missing GCS data in the study sample as well as the broader implications of losing clinically meaningful information with such a simplified score. 

By: Dr. George Mastoras
(Presented September 2013)

Epi Lesson:

Receiver-Operating Characteristic (ROC) Curves:
ROC curves are used to evaluate diagnostic data by plotting sensitivity versus 1-specificity, with higher areas under the curve (AUC) indicating better ability of the test to discriminate between patients with and without the condition. In this paper, the authors claimed than AUCs of 0.95 (which are very high) meant that the assays were very accurate in identifying MI. Unfortunately, ROC curves are not very usefulness to clinicians and particularly in the ED where we are usually focused on sensitivity or the ability of a test to rule-out a condition (SnOut). 
 
By Dr. Ian Stiell     
EMottawa

EMottawa

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