Abstract 19504: Three Common Mental Status Scoring Systems are Predictive of Adverse Events in the Inpatient Setting
Introduction: Altered mental status has been shown to be one of the most accurate predictors of adverse events in hospitalized patients. Many early warning scores utilize the Alert-Verbal-Painful-Unresponsive (AVPU) scale to characterize mental status. The Glasgow Coma Scale (GCS) and Richmond Agitation-Sedation Scale (RASS) have both been validated in critically ill and trauma patients but are not well-characterized in the general inpatient ward population. We sought to compare GCS, RASS, and AVPU in their association with adverse outcomes in hospitalized ward patients.
Methods: The nursing staff at the University of Chicago Medical Center began documenting GCS and RASS on adult ward patients once per 12-hour shift in August 2011. We conducted an electronic chart review of these hospitalizations up through February 2012. AVPU was abstracted from the eye subscale of the GCS. The primary outcome was the composite of ICU transfer, cardiac arrest, or mortality within 24 hours of an observation. Predictive accuracy was calculated and compared using the area under the receiver operating characteristic curve (AUROC).
Results: A total of 107,944 paired observations were made in 11,383 patients, of which 757 experienced at least one adverse outcome. The raw data are shown in the figure. GCS, RASS and AVPU were highly correlated with each other (Spearman’s rho of 0.57 for GCS vs. AVPU, 0.26 for RASS vs. AVPU and 0.12 for GCS vs. RASS, p<0.001 for all three pair-wise comparisons). The AUROCs for AVPU, GCS, and RASS were 0.55 (95% CI: 0.54-0.56), 0.59 (95% CI: 0.58-0.60), and 0.60 (95% CI: 0.59-0.61), respectively. Simultaneous use of RASS and GCS produced an AUROC of 0.61 (95% CI: 0.60-0.63).
Conclusions: GCS and RASS are both significantly better predictors of adverse events on the wards than the more commonly used AVPU scale, and may be worth collecting routinely in hospitalized ward patients. In addition, the combination of GCS and RASS may be more predictive than either alone.
- © 2012 by American Heart Association, Inc.