UMEM Educational Pearls

Category: Neurology

Title: Are We Using the Glasgow Coma Scale Reliably?

Keywords: Glasgow Coma Scale, GCS, traumatic brain injury, TBI, survey (PubMed Search)

Posted: 5/13/2015 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

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]