Analyzing Outcome of Treatment of Severe Head Injury: A Review and Update on Advancing the Use of the Glasgow Outcome Scale

Abstract

The Glasgow Outcome Scale (GOS), two decades after its description, remains the most widely used method of analyzing outcome in series of severely head-injured patients. This review considers limitations recognized in the use of the GOS and discusses a new approach to assessment, using a structured questionnaire-based interview. Assignments can be made to an extended eight-point scale (GOSE) as well as the original five-point approach-in each case, with a high degree of interobserver consistency. The assignments are coherent with the principles of the World Health Organization classification of impairments, disabilities, and handicaps, and their validity is supported by strong associations with the results of neuropsychological testing and assessment of general health status. The need to allow for disability existing before injury, issues concerning the time of assessment after injury, and subdivisions of the scale into "favorable" and "unfavorable" categories are discussed. It is concluded that, in its improved structured format, the Glasgow Outcome Scale should remain the primary method of assessing outcome in trials of the management of severe head injury.

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

“…Patients were neurologically evaluated using the Japan Coma scale [6] and mental state was analyzed with the revised Hasegawa Dementia Scale [7]. Postoperative condition was assessed at discharge using the Glasgow Outcome Scale (GOS) [8]. Patients with GOS showing good recovery or moderate disability were considered to have good outcomes.…”

History of Traumatic Brain Injury (TBI)

“…The major problem was generated Teasdale and Bryan Jennett [55] ( Fig.15-16). traumatic and non-traumatic [55,56,57,58,59,60]. In its original publication, the scale had ranks from 3 to 14 points [55].…”

The Glasgow Outcome at Discharge Scale: An Inpatient Assessment of Disability after Brain Injury

“…We therefore base the sample size calculation for quadratic-weighted kappa on that for the product-moment correlation coefficient r. Algina and Olejnik 18 provide tables for the product-moment correlation coefficient in terms of the sample size needed to achieve a given width of CI for a range of possible true values of r. Hence, we estimated that about 60 patients were needed for the reliability study and, from previous studies, approximately 80 to assess validity. [6][7][8][9][10] Inter-rater reliability on the GODS was assessed using the quadratic-weighted kappa and 95% CI. Concurrent and convergent validity (association between GODS and each of inpatient DRS and SF-36, respectively) was quantified by the Spearman rank correlation coefficient and 95% CI.…”

“…Both the GOS and GOS-E are simple and quick to administer and are valid and reliable when used in face to face interview, telephone interview, or in amended form by postal return. [6][7][8][9][10] The GOS is not valid in a hospital setting, however, because a key criterion is restitution of independence in society. Despite this, the GOS continues to be used inappropriately in studies on hospitalized patients, emphasizing a demand for an inpatient version.…”