Misjudged factors of Japan Coma Scale scores by junior residents: an observational study using consciousness level simulation of emergency department patients

DOI 25 References
  • Namiki Jun
    Department of Emergency and Critical Care Medicine, School of Medicine, Keio University
  • Yamazaki Motoyasu
    Department of Emergency and Critical Care Medicine, School of Medicine, Keio University
  • Funabiki Tomohiro
    Department of Emergency and Critical Care Medicine, School of Medicine, Keio University
  • Hori Shingo
    Department of Emergency and Critical Care Medicine, School of Medicine, Keio University
  • Aikawa Naoki
    Department of Emergency and Critical Care Medicine, School of Medicine, Keio University

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  • 研修医のＪａｐａｎ　Ｃｏｍａ　Ｓｃａｌｅ誤判定の要因―救急患者の意識レベルシミュレーションを用いた検討―

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Objectives: To reveal the primary factors involved in misjudgment of Japan Coma Scale (JCS) scores during the assessment of patients' consciousness levels in an emergency department (ED) setting.<BR>Methods: A video simulation portraying mock patients with eight different levels of consciousness that are frequently encountered in the ED was made. Junior residents (n=94) were asked to watch the video and to assess the consciousness levels of the mock patients according to the JCS. Their scoring results were then analyzed.<BR>Results: For the eight selected levels of consciousness, an average of 19 ± 15% (mean ± standard deviation) of the junior residents failed to provide the correct answers, as determined by the JCS. Misjudgments of JCS 0 and 300 were unusual, whereas over 20% of the examinees misjudged JCS 2, 10, and 200. When the correct JCS scores for the mock patients were compared with the incorrect answers, the examinees were found to have underestimated the consciousness levels (misjudged as a better level of consciousness, compared with the correct scores) more frequently than they had overestimated the levels. We compared the eye, verbal, and motor scores as per the Glasgow Coma Scale of the mock patients with the misjudged JCS scores and revealed the following common JCS scoring errors: 1) regarding the best motor response, the misjudgment of “withdrawal (M4)” as “JCS 100: movements to avoid stimuli”; 2) regarding verbal responses, the misjudgment of “confused conversation (V4)” as “JCS 0: normal”; and 3) regarding eye opening, the misjudgment of “to speech (E3)” as “JCS 1-digit-code: the patient is awake without any stimuli”.<BR>Conclusions: The primary factors involved in JCS scoring errors in an ED setting were the discrimination of motor responses between withdrawal and localizing pain, the discrimination between disorientation and normal, and the judgment of eye opening in response to speech.

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