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. 2022 Sep 16;9(1):e785.
doi: 10.1002/ams2.785. eCollection 2022 Jan-Dec.

Survey of Glasgow Coma Scale and PaO2/FIO2 ratio assessment methods for the Sequential Organ Failure Assessment score in Japanese intensive care units

Mitsuhiro Tamoto  1 , Takumi Imai  1 , Rei Aida  1 , Yusuke Harada  2 , Yuki Wakabayashi  3 , Gaku Satone  4 , Shunsuke Ichoda  5 , Takeshi Unoki  6 , Ayumi Shintani  1
Affiliations

Survey of Glasgow Coma Scale and PaO2/FIO2 ratio assessment methods for the Sequential Organ Failure Assessment score in Japanese intensive care units

Mitsuhiro Tamoto et al. Acute Med Surg. .

Abstract

Aim: Accurately calculating the Sequential Organ Failure Assessment (SOFA) score is essential for medical resource allocation and decision-making. This study surveyed Japanese intensive care units regarding their assessment of the Glasgow Coma Scale (GCS) and PaO2/FIO2 ratio, components of the SOFA score.

Methods: A cross-sectional, web-based survey was conducted among healthcare workers. The survey consisted of questions about the intensive care units where they work and questions for respondents. It was distributed to healthcare workers by e-mail through the Japanese Society of Intensive Care Medicine mailing list and social networking service.

Results: Among 414 responses, we obtained 211 valid responses and 175 survey results from unique intensive care units. When assessing GCS in patients under the influence of sedatives, 45.1% (95% confidence interval, 37.6-52.8) of intensive care units assessed GCS assuming that the sedatives had no influence. For the PaO2/FIO2 ratio in the SOFA score, calculation based on the Japanese Intensive Care Patient Database definition document and mechanical ventilator settings were the most common methods in patients with oxygen masks and on extracorporeal membrane oxygenation, respectively. Approximately 60% of respondents indicated that it was difficult to assess GCS assuming that sedatives had no influence.

Conclusion: In patients under the influence of sedatives, approximately half of the intensive care units assessed assumed GCS. There was variation in the methods used to assess the PaO2/FIO2 ratio. Standardized assessment methods for GCS and the PaO2/FIO2 ratio are needed to obtain valid SOFA score.

Keywords: Glasgow Coma Scale; PaO2/FIO2 ratio; SOFA score; intensive care unit; organ dysfunction scores; sedative.

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Figures

Fig. 1
Fig. 1
Survey flow diagram. Participants were required to be a HCW who worked in one of the 603 ICUs that met the criteria for medical fees of the MHLW based on data from the Regional Bureaus of Health and MHLW in February 2021. HCWs, Healthcare workers; ICU, intensive care unit; MHLW, Ministry of Health, Labor, and Welfare.
Fig. 2
Fig. 2
Distribution of respondents' ICUs by prefecture. Darker blue indicates a higher proportion or count of respondents' ICUs at the prefecture level. ICU, intensive care unit.
Fig. 3
Fig. 3
GCS assessment and P/F ratio calculation methods for the SOFA score. Situations in which GCS was assessed in patients under the influence of sedatives were as follows. Situation A, no consciousness impairment before sedation. Situation B, consciousness impairment before sedation. Situation C, consciousness impairment during sedation. JIPAD rule, calculation of the P/F ratio according to the JIPAD definition document. ICU rule, calculation of the P/F ratio as defined by each ICU. ECMO, extracorporeal membrane oxygenation; P/F, PaO2/FIO2; GCS, Glasgow Coma Scale; JIPAD, Japanese Intensive Care Patient Database; ICU, intensive care unit.
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