[How do physicians code the motoric variable of the Glasgow-Coma-Score?]. / Wie kodieren Ärzte die motorische Antwort im Glasgow-Coma-Score?

A mere 14% gave the right answer according the guidelines: Code the "best motoric answer" of the "upper limb". 86% coded the Glasgow-Coma-Score for the motoric variable falsely and inconsistently. Additionally, the rate of correct answers were higher in physicians in training (37.5%) than in qualified and certified emergency doctors (5%). Emergency doctors post training stated in 68% instances that the variable should be coded according to the neurological results at the upper or lower extremity. Furthermore, they stated that the worst neurological result should be coded (43%). From our data, it appears that the coding of the motoric variable is not done according to the guidelines or is done inconsistently. There are compelling reasons for coding the worst result. However, this procedure is contrary to the guidelines presented by literature. These guideline have never been withdrawn. Emergency doctors obviously code the motoric variable of the Glasgow-Coma-Score with knowledge about the pathophysiology of traumatic brain injuries. The Glasgow-Coma-Score is used for coding the level of consciousness at the site of accident, on admission, for prognosis, in clinical studies and in forensic controversies. Its sensitivity for depth of coma depends on the quality of coding the motoric answer. We interviewed 165 emergency doctors (in training and post training) about the guidelines for coding the motoric variable of the Glasgow-Coma-Score.

The adenosine diphosphate--adenosine triposphate-excange reaction of cerebral microsomes and its relation to he sodium ion-stimulatd adenosine-triphosphatase reaction.

Microsomes from guinea-pig cerebral cortex contain a system capable of exchanging ADP with ATP at rates of about 20mumoles/mg. of protein/hr. The ADP-ATP-exchange reaction requires Mg(2+) for activity. The reaction is not stimulated by Na(+) or K(+) and is not inhibited by ouabain, in contrast with the Na(+)-plus-K(+)-stimulated adenosine triphosphatase. The pH optimum also differs from that of the adenosine triphosphatase. The ADP-ATP-exchange reaction is stimulated two- to three-fold by non-ionic, anionic and cationic detergents, even when these agents are inhibiting the adenosine-triphosphatase reaction. This reaction may represent a component of the Na(+)-plus-K(+)-stimulated adenosine-triphosphatase reaction but is more likely to be due to other enzyme systems present in microsomal subfractions.