UMEM Educational Pearls

Title: Are We Using the Glasgow Coma Scale Reliably?

Category: Neurology

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]