Search
Are We Using the Glasgow Coma Scale Reliably?
- The Glasgow Coma Scale (GCS), first described in 1974, has been a tool used worldwide to assess and communicate the consciousness of patients with traumatic brain injury (TBI).
- There have been reports of variations in which GCS is assessed, such as differences in technique used to elicit pain and how confounding factors such as intubation are reported.
- Reith et al. conducted an international survey of 613 health care practitioners on their methodology of GCS assessment, reporting of GCS, and attitudes toward its current use in daily practice.
- Participants included nurses, intensivists, anesthesiologists, emergency physicians, and neurosurgeons
- Some variations in applications, methodology, and reporting from the survey include:
| Reported by Responders | |
| Patient population in which GCS is used | Traumatic brain injury (96%) Other neurological disorders (78%) |
| Intended purpose of GCS | Classification of severity of injury (51%) Serial evaluation of patient over time (33%) Clinical decision making (44%) Prognostication (17%) |
| Application of stimulus | Both arms and legs (62%) Only arms (37%) |
| Type of stimuli used | Nail bed pressure (57%) Lateral side of finger (22%) Supra-orbital nerve pressure (52%) Trapezius or pectoralis pinch (50%) Sternal rub (53%) Retromandibular stimulation (24%) Earlobe stimulation (16%) |
| Reporting of GCS | Description in words, e.g. no eye opening, no motor (19%) Numerical report, e.g. E1V1M1 (46%) Sum score, e.g. EVM=3 (35%) |
- This survey suggests that there is a lack of standardization of GCS assessment and reporting which affects its reliability as an assessment and communication tool
- A free educational tool has been developed (http://www.glasgowcomascale.org) to provide a standardized approach to the use of GCS
Bottom line: There are variations in the application, assessment, and reporting of the GCS. A standardized approach is needed for it to be a reliable assessment and communication tool.
References
Reith FCM, Brennan PM, Maas AIR, Teasdale GM. Lack of standardization in the use of the Glasgow Coma Scale: Results of international surveys. J Neurotrauma. 2015; May 7. [Epub ahead of print]