A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes

Gill, Michelle; Windemuth, Ryan; Steele, R.; Green, Steven M.

doi:10.1016/j.annemergmed.2004.07.429

Cited by 104 publications

(78 citation statements)

References 31 publications

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“…They assessed three methods of dealing with the verbal scoring of an aphasic patient: (1) eliminating the verbal component, (2) pseudoscoring with '1', and (3) median value substitution of the other components. Their data agrees with others' data [48][49][50][51][52][53][54], that the motor and eye components alone can accurately substitute for a complete GCS where the eye and motor subscale had 87% accuracy compared to 88% for the model with eye, motor, and verbal scale.…”

Section: Limitationssupporting

confidence: 91%

“…They note that there is a mathematical skew and calculation bias towards the motor score as a result of assigning four possible scores to eye responses, five to verbal and six to motor responses. Critics of the GCS have acknowledged this and faulted it for being overly complex and have proposed a modified GCS, with focus on the motor component which would improve ease of use and potentially predictive power when there is inability to obtain a verbal subscore [8,54]. Kelly et al tested a simple AVPU responsiveness scale which scores mental status as ''alert,'' ''responsive to verbal stimulation,'' ''responsive to painful stimulation,'' and ''unresponsive'' in comparison to the GCS.…”

Section: Limitationsmentioning

confidence: 99%

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Evaluation of Coma: A Critical Appraisal of Popular Scoring Systems

Kornbluth

Bhardwaj

2010

Neurocrit Care

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Numerous scoring scales have been proposed and validated to evaluate coma for rapid pre-hospital assessment and triage, disease severity, and prognosis for morbidity and mortality. These scoring systems have been predicated on core features that serve as a basis for this review and include ease of use, inter-rater reliability, reproducibility, and predictive value. Here we review the benefits and limitations of the most popular coma scoring systems. The methods include search of Medline, databases, and manual review of article bibliographies. Few of the many available coma scales have gained widespread approval and popularity. The best known and widely accepted scale is the Glasgow Coma Scale (GCS). The Reaction Level Scale (RLS85) has utility and proven benefit, but little acceptance outside of Scandinavia. The newer Full Outline of UnResponsiveness (FOUR) score provides an attractive replacement for all patients with fluctuating levels of consciousness and is gradually gaining wide acceptance.

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Section: Limitationssupporting

confidence: 91%

Section: Limitationsmentioning

confidence: 99%

Evaluation of Coma: A Critical Appraisal of Popular Scoring Systems

Kornbluth

Bhardwaj

2010

Neurocrit Care

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“…More recent research on the predictive ability of the GCS has compared individual components of the GCS score with the GCS total score (Gill, Windemuth, Steele, & Green, 2005;Healey et al, 2003;Ross, Liepold, Terregino, & O'Malley, 1998). Ross and associates reported that the motor component of the GCS score accurately predicted outcome in head injury patients with nearly the same accuracy as the total GCS score (motor score sensitivity 91%, specificity 85%; total GCS score sensitivity 92%, specificity 85%).…”

Section: Individual Components Of Gcsmentioning

confidence: 97%

A Review of the Predictive Ability of Glasgow Coma Scale Scores in Head-Injured Patients

McNett

2007

Journal of Neuroscience Nursing

111

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“…Over the years, considerable limitations have been identified for this scale: the inconsistent inter-observer reliability [15], the impossibility to test the verbal component in intubated patients [16,17], the exclusion of the brainstem reflexes [18], the incapacity to detect subtle changes in neurological examination, and the lack of correlation between outcome and GCS scores [19]. Attempts have been made to modify the GCS [20][21][22]. In 1982, Born et al [18] suggested that adding measures of brainstem reflexes to the GCS could improve prognostic information, but this scale-the Glasgow Liège Scale (GLS)-never had a widespread international use.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

et al. 2011

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Background The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liège Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state. Methods FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) braindamaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Interrater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136). Results GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit. Conclusions The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales.

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A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes

Cited by 104 publications

References 31 publications

Evaluation of Coma: A Critical Appraisal of Popular Scoring Systems

Evaluation of Coma: A Critical Appraisal of Popular Scoring Systems

A Review of the Predictive Ability of Glasgow Coma Scale Scores in Head-Injured Patients

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

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