COMPARISON OF GCS VS MOTOR COMPONENT ALONE AS AN EFFECTIVE PREDICTOR IN SEVERE HEAD TRAUMA TRIAGE.

J Peop Univ Med Health Sci. 2025:15(3), 71-79. http://doi.org/10.46536/jpumhs/2025/15.03.660

Abstract

BACKGROUND: Severe head trauma is a leading cause of disability and mortality
worldwide, particularly among young adults, and imposes a substantial burden on healthcare
systems. OBJECTIVES: This study aims to compare the accuracy of the total GCS (GCSt) versus
the GCS motor component (GCSm) alone in triaging patients with head trauma. METHODS: This
six-month longitudinal study was conducted in the Emergency Department of Ziauddin University
Hospital, Karachi, enrolling 127 head trauma patients (aged 18–60) via consecutive sampling. Those
with ischemic stroke, GCS score of 3, polytrauma, spinal trauma, and prior neurologic conditions
were excluded. Background information, vitals and trauma details were recorded, and each patient
was assessed using both GCSt and GCSm. Diagnostic accuracy measures sensitivity, specificity, PPV,
NPV, and ROC curves were calculated. RESULTS: The mean patient age was 43.0 ± 13.0 years;
65.35% were male. Road traffic accidents were the leading cause of head injury, followed by falls.
For severe cases; the GCSm demonstrated perfect diagnostic performance with 100% sensitivity,
specificity, PPV, NPV, and overall accuracy. In moderate cases, GCSm showed 91.38% sensitivity,
100% specificity, and 96.88% accuracy, with only two false negatives. For mild cases, GCSm
achieved 100% sensitivity, 96.55% specificity, and 98.35% accuracy. ROC analysis showed excellent
discriminative ability for both GCSt (AUC 0.916; 95% CI: 0.866–0.966) and GCSm (AUC 0.914;
95% CI: 0.862–0.965), both p<0.001. GCSm consistently demonstrated high diagnostic accuracy
across all injury severities and mechanisms, including RTAs and falls CONCLUSION: The GCS
motor component showed high diagnostic accuracy across head trauma severities, closely aligning
with total GCS performance, and demonstrated near-perfect sensitivity and specificity in mild and
severe cases. Its simplicity and reliability make GCSm a strong, efficient alternative for routine triage
in emergency care.