Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians

Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality

“…As an early available stratification tool of great importance, the reliability of the GCS is of great relevance5. However, reservations have been expressed and, in particular, interrater reliability seems to vary from critical to moderate6, 18, 19. Previous studies have shown varying interrater reliability within the three GCS subgroups, with the eye and verbal response components showing the lowest interrater reliability18.…”

“…Pharmacological (therapeutic) influence and traumatic paralysis due to spinal cord injury can bias assessment findings and lead to misinterpretation4. Furthermore, evaluation of the GCS score might be tempered by poor compliance6, 18, 19. A previous study found that the highest misjudgement rate in GCS score evaluations was for the verbal response component18.…”

“…As TBI is a leading cause of death in the trauma population, the inclusion of data from these patients might have masked potential deaths caused by other concomitant diseases. Moreover, evaluation of the GCS shows interrater variability5, 6, 18, 19, and the assignment of scores is likely to be subject to local conventions that were almost certainly not uniform and thus may have biased the study results in unforeseeable ways. Nevertheless, this study was based on a large data set, allowing for a comprehensive examination of the GCS score, pupil size and reactivity.…”

Does the AIMS65, a new risk score for upper gastrointestinal bleeding, work in Japan?

“…The assessment of ‘confused conversation (V4)’ and ‘withdrawal motor response (M4)’ are reported as primarily misjudged GCS factors. Additional instructions, especially for these misjudged factors, are needed for the accurate evaluation of the GCS …”

Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality (Br J Surg 2012; 99(Suppl 1): 122–130)

“…There has been an ongoing debate about the validity of the summarized GCS score in predicting outcome after traumatic brain injury (TBI). This debate relates to multiple confounding factors, including the issue of interobserver variability, the accuracy of initial scoring by inexperienced physicians, the distraction by associated injuries in patients with polytrauma, and the question of whether the ‘dilution’ of the three components in a summarized score decreases the predictive value of the individual parameters2–4.…”