Title: Are We Using the Glasgow Coma Scale Reliably?<br/>Author: Wan-Tsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><p>
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        <span style="font-size:12px;"><strong>Are We Using the Glasgow Coma Scale Reliably?</strong></span></p>
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                <span style="font-size:12px;">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).</span></li>
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                <span style="font-size:12px;">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.</span></li>
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                <span style="font-size:12px;">Reith <em>et al</em>. 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.</span>
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                                <span style="font-size:12px;">Participants included nurses, intensivists, anesthesiologists, emergency physicians, and neurosurgeons</span></li>
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                <span style="font-size:12px;">Some variations in applications, methodology, and reporting from the survey include:</span></li>
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                                <span style="font-size:12px;">Reported by Responders</span></td>
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                                <span style="font-size:12px;">Patient population in which GCS is used</span></td>
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                                        <span style="font-size:12px;">Traumatic brain injury (96%)</span></div>
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                                        <span style="font-size:12px;">Other neurological disorders (78%)</span></div>
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                                <span style="font-size:12px;">Intended purpose of GCS</span></td>
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                                        <span style="font-size:12px;">Classification of severity of injury (51%)</span></div>
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                                        <span style="font-size:12px;">Serial evaluation of patient over time (33%)</span></div>
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                                        <span style="font-size:12px;">Clinical decision making (44%)</span></div>
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                                        <span style="font-size:12px;">Prognostication (17%)</span></div>
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                                <span style="font-size:12px;">Application of stimulus</span></td>
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                                        <span style="font-size:12px;">Both arms and legs (62%)</span></div>
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                                        <span style="font-size:12px;">Only arms (37%)</span></div>
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                                <span style="font-size:12px;">Type of stimuli used</span></td>
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                                        <span style="font-size:12px;">Nail bed pressure (57%)</span></div>
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                                        <span style="font-size:12px;">Lateral side of finger (22%)</span></div>
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                                        <span style="font-size:12px;">Supra-orbital nerve pressure (52%)</span></div>
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                                        <span style="font-size:12px;">Trapezius or pectoralis pinch (50%)</span></div>
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                                        <span style="font-size:12px;">Sternal rub (53%)</span></div>
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                                        <span style="font-size:12px;">Retromandibular stimulation (24%)</span></div>
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                                        <span style="font-size:12px;">Earlobe stimulation (16%)</span></div>
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                                <span style="font-size:12px;">Reporting of GCS</span></td>
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                                        <span style="font-size:12px;">Description in words, e.g. no eye opening, no motor (19%)</span></div>
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                                        <span style="font-size:12px;">Numerical report, e.g. E1V1M1 (46%)</span></div>
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                                        <span style="font-size:12px;">Sum score, e.g. EVM=3 (35%)</span></div>
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                <span style="font-size:12px;">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</span></li>
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                <span style="font-size:12px;">A free educational tool has been developed (<a href="http://www.glasgowcomascale.org">http://www.glasgowcomascale.org</a>) to provide a standardized approach to the use of GCS</span></li>
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        <span style="font-size:12px;"><strong><u>Bottom line</u>:</strong> 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.</span></p>
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<fieldset><legend>References</legend>

                <p>
        Reith FCM, Brennan PM, Maas AIR, Teasdale GM. Lack of standardization in the use of the Glasgow Coma Scale: Results of international surveys. <em>J Neurotrauma</em>. 2015; May 7. [Epub ahead of print]</p>
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