Simplified Motor Score (SMS)
For evaluation of patients in the pre-hospital and acute care setting for possible traumatic brain injury.
The Simplified Motor Score (SMS) has been suggested as a replacement for the GCS in the evaluation of patients for traumatic brain injury.
- A meta-analysis of 5 studies (102,132 total subjects) found that for predicting clinically significant TBI, need for neurosurgery, and need for intubation, the SMS and GCS were statistically equivalent.
- A prospective study involving 126 trauma patients found that the SMS had significantly greater inter-rater reliability (83%) than the GCS (32%) when performed within 5 minutes of each by two ED physicians who were blinded to the other’s assessments.
Points to keep in mind:
- It should be noted that all comparisons of the discriminatory value of the SMS compared to the GCS were retrospective reviews of prospectively collected registry data.
- There is no published data on whether observed differences in performance between the SMS and GCS are truly clinically insignificant as is asserted by the authors of several of the comparative studies.
The Simplified Motor Score allows providers to rapidly assess trauma patients using a score that is significantly simpler than the GCS, has higher inter-rater reliability and comparable sensitivity for significant traumatic brain injury, the need for neurosurgery and/or intubation and death.
Though the composite GCS has been almost universally adopted, there are concerns about its poor reproducibility and the validity of using the composite score. The SMS offers a convenient and viable alternative.