Assessing the Relationship between Glasgow Coma Scale Scores and MS Documentation in Allogeneic Hematopoietic Cell Transplant Recipients with Suspected Infection

Topic Significance & Study Purpose/Background/Rationale Sepsis leads to physiologic shock, organ dysfunction and death. Mental status (MS) changes are known indicators of sepsis, so clinical criteria that measure awareness and mentation have been incorporated in sepsis screening tools such as the quick Sequential Organ Failure Assessment (qSOFA). To evaluate the utility of GCS as a MS assessment tool, we examined the relationship between GCS scores and MS clinical record documentation in allogeneic hematopoietic cell transplant (aHCT) recipients with suspected infections (SI). Methods, Intervention, & Analysis We retrospectively examined aHCT recipients with SI who were transplanted between September 2010 and July 2017. We assessed data from the first 100-days post-HCT using clinical databases and medical records. We defined SI as an antibiotic and a culture within a specific time epoch. We randomly selected a cohort of inpatient detected SIs (n=100) based on presence of GCS availability: 30 SIs with and 70 SIs without a GCS score recorded 24 hrs after SI onset. Using a selection of search terms associated with MS changes, chart-review was done to ascertain clinical MS assessments conducted by healthcare staff within 24 hours of SI onset. Findings & Interpretation A total of 773/1170 (66.1%) patients had 1 or more SIs. The 773 recipients experienced 1,655 SIs during follow-up, of which, 625 (37.8%) had a documented GCS score within 24 hours of onset. Of the selected cohort, those with GCS scores had a median of 3 current MS notes, compared to 2 among those without GCS scores. Among patients with SIs and GCS scores, 8 had documented altered MS, including 3 with GCS scores of 15 and 5 with scores of Discussion & Implications GCS scores are often used in sepsis screening tools, yet the frequency and accuracy of documentation among aHCT recipients has not been assessed. We found that the majority of aHCT recipients did not have GCS score within 24 hours of a suspected infection. Additionally, GCS scores did not always correlate with healthcare staff documentation of post-transplant altered MS.