Factors Influencing the Reliability of the Glasgow Coma Scale: A Systematic Review

Reith, Florence C.M.; Synnot, Anneliese; Brande, Ruben van den; Gruen, Russell L.; Maas, Andrew I.R.

doi:10.1093/neuros/nyw178

Cited by 48 publications

(25 citation statements)

References 62 publications

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“…2,3 Likewise, although the Glasgow Coma Scale (GCS) provides a broad catego-rization of injury severity, its inter-rater reliability and consistency in predicting outcome has been questioned. 4,5 The struggle to find reliable indicators of injury severity and outcome arises from the multifaceted nature of TBI. The acute biological response to TBI is a systemic process that involves, among other pathologies, complex inflammatory and immunomodulatory cascades.…”

Section: Introductionmentioning

confidence: 99%

Testing a Multivariate Proteomic Panel for Traumatic Brain Injury Biomarker Discovery: A TRACK-TBI Pilot Study

Huie

Yue

Sorani

et al. 2019

Journal of Neurotrauma

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The complex and heterogeneous nature of traumatic brain injury (TBI) has rendered the identification of diagnostic and prognostic biomarkers elusive. A single acute biomarker may not be sufficient to categorize injury severity and/or predict outcome. Using multivariate dimension reduction analyses, we tested the sensitivity and specificity of a multi-analyte panel of proteins as an ensemble biomarker for TBI. Serum was collected within 24 h of injury in a cohort of 130 patients enrolled in the multi-center prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study and run on an array that measured 72 proteins. Using unsupervised principal components analysis, we first identified the subset of protein changes accounting for the most variance across patients. This yielded a group of 21 proteins that reflected an inverse relationship between inflammatory cytokines and regulators of anti-inflammation, and generated an individual inflammatory profile score for each patient. We then tested the association between these scores and computed tomography (CT) findings at hospital admission, as well as their prognostic association with functional recovery at 3 and 6 months (Glasgow Outcome Scale-Extended), and cognitive recovery at 6 months (California Verbal Learning Test, Second Edition) after injury. Inflammatory signatures were significantly increased in patients with positive CT findings, as well as in those who showed poor or incomplete recovery. Inflammation biomarker scores also showed significant sensitivity and specificity as a discriminator of these outcome measures (all areas under the curve [AUCs] >0.62). This proof of concept for the feasibility of multivariate biomarker identification demonstrates the prognostic validity of using a proteomic panel as a potential biomarker for TBI.

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Section: Introductionmentioning

confidence: 99%

Testing a Multivariate Proteomic Panel for Traumatic Brain Injury Biomarker Discovery: A TRACK-TBI Pilot Study

Huie

Yue

Sorani

et al. 2019

Journal of Neurotrauma

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“…Our findings are in consonance with the recommendations of systematic review on the subject of factors influencing the reliability of the GCS. 8 Limitations of our study include small number of participants. However, we had a variable group of participants, from junior-most to final year with varied learning, all of them showing improvement in the most important aspect of GCS scoring, that is, motor component.…”

Section: Discussionmentioning

confidence: 92%

“…Our findings are in consonance with the recommendations of systematic review on the subject of factors influencing the reliability of the GCS. 8 …”

Section: Discussionmentioning

confidence: 99%

“…Training and education is important for reliability of the GCS scoring. 8 Though the GCS assessment is taught during the undergraduate medical training, the postgraduates and practicing physicians often miscalculate the GCS score. 9 It takes not only time and practice to master the GCS assessment, but also a certified trainer/doctor to teach it.…”

Section: Introductionmentioning

confidence: 99%

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Teaching Glasgow Coma Scale Assessment by Videos: A Prospective Interventional Study among Surgical Residents

Bajaj

Rathore

Parihar

et al. 2020

JNRP

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Objective Glasgow Coma Scale (GCS) assessment is vital for the management of various neurological, neurosurgical, and critical care disorders. Learning GCS scoring needs good training and practice. Due to limitation of teachers, the new entrants of the clinical team find it difficult to learn and use it correctly. Training through videos is being increasingly utilized in the medical field. This study aimed to evaluate the efficiency of video teaching of GCS scoring among general surgery residents. Materials and Methods A prospective study was done utilizing the freely available video at glasgowcomascale.org. The participants (general surgery residents, 1st–3rd year) were asked to assess and record their responses related to GCS both before and after watching the video. A blinded neurosurgeon recorded the correct responses separately. Statistical Analysis The difference between correct responses of the residents before and after watching the video was calculated using the “chi-square test.” p-Value ≤ 0.05 was taken as significant. Results There was a significant improvement in GCS scoring by residents after watching the videos (p < 0.05). On estimating the responses separately, all the three responses (eye, verbal, and motor) improved significantly for 1st-year residents while only the motor response improved significantly for 2nd- and 3rd-year residents. The mode subjective improvement for the 1st-, 2nd-, and 3rd-year residents was 5, 4, and 3, respectively. Conclusion Training GCS scoring through videos is an effective way of teaching the surgery residents with maximum benefit to the junior-most ones.

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“…The secondary outcome of this study, the assessment of IC with the GCS at 14 days, was performed by trained health care providers, but again interrater variability cannot be excluded. The reliability may be improved with further standardization of assessment and corresponding training …”

Section: Discussionmentioning

confidence: 99%

Comparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury

Pannatier

Delhumeau

Walder

2018

Acta Anaesthesiol Scand

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Factors Influencing the Reliability of the Glasgow Coma Scale: A Systematic Review

Abstract: Reliability of the GCS is influenced by multiple factors and as such is context dependent. This review points to the potential for improvement from training and education and standardization of assessment methods, for which recommendations are presented.

Cited by 48 publications

References 62 publications

Testing a Multivariate Proteomic Panel for Traumatic Brain Injury Biomarker Discovery: A TRACK-TBI Pilot Study

Testing a Multivariate Proteomic Panel for Traumatic Brain Injury Biomarker Discovery: A TRACK-TBI Pilot Study

Teaching Glasgow Coma Scale Assessment by Videos: A Prospective Interventional Study among Surgical Residents

Comparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury

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