Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.

Abstract

SUMMARY The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality oflife in disabled survivors.

The Glasgow Outcome Scale — 40 years of application and refinement

“…An original driver for the development of a robust outcome scale was the realization that multicentre studies of outcomes after coma were needed to address the issue of balancing reductions in mortality rate with survival and quality of life 7 . The GOS was, therefore, designed and published in this context.…”

“…[H2] Dichotomization of outcomes Despite early criticism of the GOS for "over-compressing" survival outcome 7 , a convention developed for dichotomising the five-point GOS scale into 'unfavourable' (Dead, Vegetative or Severe Disability) or 'favourable' (Moderate Disability or Good Recovery) outcomes. This dichotomy reflects the view that independent function, rather than survival with disability that leaves patients dependent, is the desired outcome because head injury is most common among young adults.…”

“…The later description of the extended GOS (GOSE) 7 is in the top 25 cited papers on traumatic brain injury (TBI) 8 . The GOS in its original or extended form is recommended as the outcome measure to be used for major trauma and for head injury by, among others, the National Institute of Neurological Disorders and Stroke, the NIH National Institute of Child Health and Human Development TBI Clinical Trials Network and the Department of Health in England [9][10][11] .…”

Mild Traumatic Brain Injury: Adapting to Consequences

“…Jennett, Snoek, Bond & Brooks (1981) extended the GOS-E from five categories to eight categories which are: dead, vegetative state, lower severe disability, upper severe disability, lower moderate disability, upper moderate disability, lower good recovery and upper good recovery (Sander, 2002).…”

Environmental enrichment increases progenitor cell survival in the dentate gyrus following lateral fluid percussion injury

“…Among the many consequences of TBI, persistent cognitive deficits, including impairments in memory and learning, are especially common and a major obstacle to functional recovery [40,64,69]. The specific neuropathological causes of the learning and memory impairments following TBI have been difficult to define because of the heterogeneity of the disorder, but damage to the temporal lobes, including the hippocampus is common [24].…”