The reliability of the Glasgow Coma Scale: a systematic review

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

doi:10.1007/s00134-015-4124-3

Cited by 183 publications

(143 citation statements)

References 81 publications

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“…This is partly addressed by the validation of this approach by the IMPACT model 1021 Second, there is some variability in the reporting of GCS, such that ‘first’ GCS is sometimes used interchangeably with ‘postresuscitation’ GCS 21. Third, we have not addressed the decision-making with regard to transfer of patients from peripheral to neurosurgical centres, and the possibility of regional variation.…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

et al. 2016

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ObjectivesTo provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units.DesignThe Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015.SettingData were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14n) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed.ResultsWe identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot.ConclusionsWe provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales.

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Section: Discussionmentioning

confidence: 99%

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

et al. 2016

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“…A score of 13 to 15 indicates a mild brain injury, 10 to 12 a moderate brain injury, and 3 to 8 a severe brain injury. The reliability of the GCS has been reviewed on 52 studies with seven deemed high-quality studies whose intra-class correlation coefficients indicated the GCS to be reliable and valid measure of neurocognitive state (Reith et al, 2016). …”

Section: Methods and Measuresmentioning

confidence: 99%

Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization

Reuter‐Rice

Doser

Eads

et al. 2017

Journal of Pediatric Nursing

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“…The Glasgow Coma Scale (GCS), first introduced in 1974 by Teasdale G et al ., was created to simplify assessment of the depth and duration of impaired consciousness and coma 3 . It provides a structured and objective grading system for bedside assessment 4 . In clinical settings, such as the intensive care unit and neurosurgical unit, it has been used universally for more than 40 years.…”

Section: Introductionmentioning

confidence: 99%

Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis

Zhang

Wei

Peng

et al. 2017

Sci Rep

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Traumatic brain injury (TBI) often leads to impaired consciousness. Recent diffusion tensor imaging studies associated consciousness with imaging metrics including fractional anisotropy (FA) and apparent diffusion coefficient (ADC). We evaluated their correlations and determined the best index in candidate regions. Six databases were searched, including PubMed and Embase, and 16 studies with 701 participants were included. Data from region-of-interest and whole-brain analysis methods were meta-analysed separately. The FA-consciousness correlation was marginal in the whole-brain white matter (r = 0.63, 95% CI [0.47, 0.79], p = 0.000) and the corpus callosum (CC) (r = 0.60, 95% CI [0.48, 0.71], p = 0.000), and moderate in the internal capsule (r = 0.48, 95% CI [0.24, 0.72], p = 0.000). Correlations with ADC trended negative and lacked significance. Further subgroup analysis revealed that consciousness levels correlated strongly with FA in the CC body (r = 0.66, 95% CI [0.43, 0.89]), moderately in the splenium (r = 0.58, 95% CI [0.38, 0.78]), but insignificantly in the genu. In conclusion, FA correlates better with consciousness levels than ADC in TBI. The degree of correlation varies among brain regions. The CC (especially its splenium and body) is a reliable candidate region to quantitatively reflect consciousness levels.

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The reliability of the Glasgow Coma Scale: a systematic review

Cited by 183 publications

References 81 publications

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization

Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis

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