@article{ref1,
title="Gestalt clinical severity score (GCSS) as a predictor of patient severity of illness or injury",
journal="American journal of emergency medicine",
year="2023",
author="Shiber, Joseph and Fontane, Emily and Patel, Jignesh and Akinleye, Adeolu and Kerwin, Andy and Chiu, William and Scalea, Thomas",
volume="66",
number="",
pages="11-15",
abstract="OBJECTIVE: To determine if clinical judgement is accurate to predict the severity of injury or illness, and can be used at patient arrival when other formal scoring systems are not yet available. <br><br>DESIGN: A multicenter pilot study using a prospective observational convenience sample of patients arriving by EMS to the emergency department (ED) or Trauma Center. SETTING: Two urban, Level 1 trauma centers at academic tertiary care hospitals. PATIENTS: Medical and trauma patients age 18 and older transported by EMS (N = 216). Exclusion criteria (prior to arrival): intubation, assisted ventilation (BVM or NPPV), CPR in progress, prisoners, or previously present motor or speech deficits. MEASUREMENTS: Completion of a novel 15-point scale of Verbal, Motor, and Facial Expression within 1-2 min of arrival by a clinician outside of the treatment team. Primary endpoint was the immediate disposition from the ED or Trauma Center: Home, Brief Observation (<24 h), Admission to Floor, ICU (OR and IR as surrogates since these patients ultimately go to the ICU), or Morgue. <br><br>RESULTS: Univariate analysis revealed a strong, positive monotonic correlation between GCSS and disposition (Rho = 0.693, p <.0001). Multivariable logistic regression revealed the &quot;best&quot; model included GCSS and age (group 18-44 years old versus all the other age groups) (p <.0001). There was a 156% increase in the odds of being discharged home (versus being admitted) for a one-unit increase in GCSS (OR = 2.56, 95% CI 1.94, 3.37). <br><br>CONCLUSIONS: Physicians can make accurate predictions of severity of injury and illness using a gestalt method and the scoring system we have developed as patient disposition correlates well with GCSS score. GCSS is most accurate with the 18-44 age group.<p /> <p>Language: en</p>",
language="en",
issn="0735-6757",
doi="10.1016/j.ajem.2023.01.005",
url="http://dx.doi.org/10.1016/j.ajem.2023.01.005"
}