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PubMed1993

The Glasgow Coma Scale: a mathematical critique.

The Glasgow Coma Scale permits 120 possible mathematical combinations of eye, verbal and motor scores. Out of these only about 15 are clinically valid and useful in the assessment of altered consciousness. A mathematical analysis of this pruned scale shows a predominant skew towards the motor response. Without clinically altering the scale. The numerical values can be modified to produce a more equitable dominance by each of the factors and greater precision. This is also necessary as the value of a unit is the same in the sum score, whether contributed by the eye, verbal or motor elements.

Coma↗
PubMedDate not supplied

Relationship between Glasgow coma scale and functional outcome.

The Glasgow Coma Scale (GCS) is routinely used in the acute care setting after traumatic brain injury (TBI) to guide decisions in triage, based on its ability to predict morbidity and mortality. Although the GCS has been previously demonstrated to predict mortality, efficacy in prediction of functional outcome has not been established. The purpose of this study was to assess the value of the acute GCS in predicting functional outcome in survivors of TBI. This study used the Multicenter National Institute on Disability and Rehabilitation Research TBI Model Systems database of 501 patients who had received acute medical care and inpatient rehabilitation within a coordinated neurotrauma program for treatment of TBI. Initial and lowest 24 hr GCS scores were correlated with the following outcome measures: the Disability Rating Scale (DRS), Rancho Los Amigos Levels of Cognitive Functioning Scale (LCFS), and cognitive and motor components of the Functional Independence Measure (FIM(SM)-COG and FIM(SM)-M). Outcome data were collected at admission to and discharge from the inpatient TBI rehabilitation unit. Correlation analysis revealed only modest, but statistically significant, relationships between initial and lowest GCS scores and outcome variables. Initial and lowest GCS score comparison with outcome demonstrated the following correlation coefficients: admission DRS, -0.25 and -0.28; discharge DRS, -0.24 and -0.24; admission LCFS, 0.31 and 0.33; discharge LCFS, 0.27 and 0.25; admission FIM-COG, 0.36 and 0.37; discharge FIM-COG, 0.23 and 0.23; admission FIM-M, 0.31 and 0.31; discharge FIM-M, 0.25 and 0.21. The GCS as a single variable may have limited value as a predictor of functional outcome.

Adolescent↗
PubMed2001

Prediction of neuropsychiatric outcome following mild trauma brain injury: an examination of the Glasgow Coma Scale.

The relationship between the Glasgow Coma Scale (GCS) and neuropsychiatric outcome was examined in 57 consecutive subjects with mild traumatic brain injury (TBI) attending a follow-up clinic. Subjects were grouped according to initial GCS score (15 versus 13-14) and contrasted at an average of 5-6 months post-injury. As expected, those with GCS 13-14 had longer PTA (p = 0.001) and a higher rate of abnormal brain CT scans (p = 0.005). However, no significant differences emerged for indices of neuropsychiatric status, including measures of neurobehavioural symptoms/signs, overall psychological distress, psychiatric 'caseness', functional and psychosocial outcome, frequency of common somatic complaints, and rate of return to work. Subsidiary analyses based upon the presence/absence of CT abnormalities and the duration of PTA (<1 hour versus 1-24 hours) also failed to predict outcome, although a trend associating longer PTA with lower functional outcome was observed. Thus, despite early neurosurgical differences, the results suggest that initial GCS scores do not clearly translate into neuropsychiatric sequelae at follow-up within the rubric of GCS 13-15.

Adult↗
PubMed1982

[The Glasgow coma scale].

The value of the Glasgow coma scale is definite and widely accepted. It is a help in teaching a difficult subject, in mutual understanding in a few words, and in comparison of cases. It uses accurate and practical observations. It is the best method of measuring the state of consciousness, provided observation of the diameter and light reaction of the pupils is added It avoids what Jamieson and Yelland feared in 1968. "It is tragic if the wardmaid assesses deterioration by recognizing that a patient is not as bright now as earlier while trained staff await the development of the next stage in their preconceived, rigid scale of deterioration."

Coma↗
PubMed2001

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury.

OBJECTIVE: To study the effect of hyperbaric oxy gen (HBO) treatment of severe brain injury. METHODS: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before a nd after hyperbaric oxygen treatment. RESULTS: In the treatment group GCS, BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P<0.01-0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P<0.01-0.001), the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P<0.01-0.001). CONCLUSIONS: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Adult↗
PubMed2006

A comparison of five simplified scales to the out-of-hospital Glasgow Coma Scale for the prediction of traumatic brain injury outcomes.

BACKGROUND: The 15-point Glasgow Coma Scale (GCS) frequently is used in the initial evaluation of traumatic brain injury (TBI) in out-of-hospital settings. We hypothesized that the GCS might be unnecessarily complex for out-of-hospital use. OBJECTIVES: To assess whether a simpler scoring system might demonstrate similar accuracy in the prediction of TBI outcomes. METHODS: We performed a retrospective analysis of a trauma registry consisting of patients evaluated at our Level 1 trauma center from 1990 to 2002. The ability of out-of-hospital GCS scores to predict four clinically relevant TBI outcomes (emergency intubation, neurosurgical intervention, brain injury, and mortality) by using areas under receiver operating characteristic curves (AUROCs) was calculated. The same analyses for five simplified scales were performed, and compared with the predictive accuracies of the total GCS score. RESULTS: In this evaluation of 7,233 trauma patients over a 12-year period of time, the AUROCs for the total GCS score were 0.83 (95% confidence interval [CI] = 0.81 to 0.84) for emergency intubation, 0.86 (95% CI = 0.85 to 0.88) for neurosurgical intervention, 0.83 (95% CI = 0.82 to 0.84) for brain injury, and 0.89 (95% CI = 0.88 to 0.90) for mortality. The five simplified scales approached the performance of the total GCS score for all clinical outcomes. CONCLUSIONS: In the evaluation of injured patients, five simplified neurological scales approached the performance of the total GCS score for the prediction of four clinically relevant TBI outcomes.

Adolescent↗
PubMed1995

Problems of the Glasgow Coma Scale with early intubated patients.

The Glasgow Coma Scale is probably the most common grading scale in neurotraumatology all over the world. Its validity concerning severity and prognosis of the injury has been established in the Anglo-American literature. Data derived from the German rescue system, however is different from the Anglo-American in some respects. The analysis of a well-defined group of German trauma patients with moderate and severe head injuries (n = 299) shows that low Glasgow Coma Scores (GCS 3-6) established during the first two posttraumatic days must not correspond directly to the outcome after one year. Especially for the best Glasgow Coma Score during the day after the injury, GCS 4 had a poorer collective long-term prognosis than GCS 3. Therefore, German data from head injury studies based on the Glasgow Coma Scoring are difficult to compare to those cited in the Anglo-American literature. Any statistical analysis of a so called "ranking scale" which does not satisfy its own claims under special conditions is difficult.

Brain Injuries↗
PubMed2003

The prognostic value of the components of the Glasgow Coma Scale following acute stroke.

BACKGROUND: The Glasgow Coma Scale (GCS) is widely used in assessing level of consciousness. The GCS verbal component may be misleading in acute stroke: a focal neurological deficit leading to dysphasia could affect the score, independently of level of consciousness. AIM: To investigate the relationship, in all strokes and in dysphasic patients, between stroke outcome and total GCS (with and without the verbal score) and its components, to assess their relative values. STUDY DESIGN: Retrospective analysis following prospective data collection in an acute stroke unit and follow-up. METHODS: Outcomes studied were 2-week mortality and 3-month recovery (survival, subject living at home). We used area under the receiver operating characteristic curve (AUC) to compare versions of the GCS and multivariate logistic regression to identify which subset of GCS components best predicted outcome. RESULTS: Of 1517 patients with acute stroke, 1217 had complete clinical and follow-up data; 349 were dysphasic. Total GCS had greater AUC than the GCS without the verbal score, for mortality (all patients 0.78 vs. 0.76, p=0.021; dysphasics 0.72 vs. 0.71, p=0.52) and recovery (all patients 0.71 vs. 0.67, p=0.0001; dysphasics 0.74 vs. 0.70, p=0.055). Verbal and eye scores independently provided prognostic information, for each patient group and outcome measure. CONCLUSIONS: The GCS contains valuable predictive information. Regardless of whether dysphasia is present, the verbal score should be assessed since it adds prognostic information to that from the eye component, and has greater value than the motor score.

Aged↗
PubMed1993

A physiological coma scale: grading of coma by combined use of brain-stem trigeminal and auditory evoked potentials and the Glasgow Coma Scale.

Forty-five comatose patients were prospectively studied by means of clinical examination and evoked potentials. In each patient, clinical data included Glasgow Coma Scale (GCS) score, age, pupillary response to light, corneal reflex, and eye movements. Neurophysiological evaluation was based on brain-stem trigeminal evoked potentials (BTEPs) and brain-stem auditory evoked potentials (BAEPs). For each physiological test, a progressive grading system was designed. This system was based on the evaluation of central conduction times along the trigeminal and the auditory pathways within the brain-stem. The accuracy of the clinical and the neurophysiological indicants in predicting "favorable" or "unfavorable" outcome was assessed singly and in combination. Of the clinical indicants, the GCS provided the most accurate prognosis (80%). Similar results were provided by the BAEP and the BTEP, with significant improvement in the confidence of outcome prediction. No significant difference in the accuracy of outcome predictions could be found between combined clinical data and neurophysiological data. However, the combination of clinical and neurophysiological data markedly increased both the accuracy and the confidence of outcome prediction, reaching 86% correct predictions at the over 90% confidence level with only 2% false pessimistic errors. According to these findings, a clinical-physiological coma scale, the trigeminal-auditory Glasgow (Coma Scale) score (TAG score) was designed. The TAG score demonstrated the highest accuracy at each confidence level as compared to other single indicants. We concluded that the TAG score may improve the evaluation of deep comatose patients and assist the physician in the management of such patients.

Adolescent↗
PubMed1983

Evaluation of level of consciousness by the Glasgow coma scale in children with Reye's syndrome.

The Glasgow Coma Scale, which was designed to evaluate level of consciousness after head trauma, has been compared to the Lovejoy scale in 21 patients with Reye's syndrome. Like other investigators, we have noted a poorer prognosis in those patients with higher peak NH3 levels and rapid progression of disease. However, we have also noted that the Glasgow coma scale provides a better, earlier indicator of progressive central nervous system disease than the Lovejoy scale and, therefore, helps physicians caring for such patients to institute intracranial pressure (ICP) monitoring and vigorous measures for the control of elevated ICP earlier than they might otherwise.

Child↗
PubMed1993

Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study.

OBJECTIVE: To investigate the ability of the Glasgow Coma Scale score to predict hospital mortality rate for adult medical-surgical intensive care unit (ICU) patients without trauma. DESIGN: A prospective cohort analysis of adult medical-surgical patients from a nationally representative sample of 40 U.S. hospitals. PATIENTS: 15,973 consecutive, nontraumatic ICU admissions and a comparison group of 687 head trauma admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients' gender, age, treatment location before ICU admission, comorbidities, admission diagnosis, daily physiologic measurements, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation (APACHE III) score, subsequent hospital mortality rate, and unit-specific sedation practices were noted. Hospital mortality rates were stratified by the first ICU day Glasgow Coma Scale score for all admissions. The relationship between the Glasgow Coma Scale score and outcome for two high mortality medical diagnoses (post-cardiac arrest and sepsis) were also examined and compared to the relationship found in patients with head trauma. The Glasgow Coma Scale score on ICU admission had a highly significant (r2 = .922, p < .0001) but nonlinear relationship with subsequent outcome in ICU patients without trauma. Discrimination of patients into high- or low-risk prognostic groups was good, but discrimination in the intermediate levels (Glasgow Coma Scale score of 7 to 11) was reduced. This relationship varied within the operative and nonoperative groups, and also within different disease categories, various age groups, and certain ranges of the Glasgow Coma Scale score. A reduced initial Glasgow Coma Scale score associated with sepsis was a combination of factors associated with a higher mortality rate than that found in patients with head trauma. The proportion of patients who could not be assigned a Glasgow Coma Scale score because of sedation/paralysis varied widely across ICUs. The overall predictive capability of the APACHE III Prognostic Scoring System was improved by incorporating the Glasgow Coma Scale score. CONCLUSIONS: We demonstrated the prognostic importance of admission levels of consciousness as measured by the Glasgow Coma Scale score on ICU and hospital mortality rates. We concluded that the Glasgow Coma Scale score may be used to stratify and predict mortality risk in general intensive care patients, but lack of sensitivity in the intermediate range of Glasgow Coma Scale Score should be noted. Ideally, the Glasgow Coma Scale score should also be applied in the context of other physiologic information and the patient's specific diagnosis. Variation in the use of sedatives in different ICUs means that imputing or substituting a value other than normal for an unobtainable Glasgow Coma Scale score may introduce a substantial treatment bias into subsequent outcome predictions.

Coma↗
PubMed1996

[Evaluation of prognosis in purulent meningitis-myelitis based on the Glasgow Coma Scale].

We presented data from the investigation of the usefulness of the Glasgow Coma Scale in predicting the outcome of bacterial meningitis. Patients who aggregated high Glasgow Coma Scale scores had a good prognosis, whereas those patients with low scores had a very poor prognosis, inspite of this limitation the Glasgow Coma Scale seems to be a valuable supplement to the physical examination of patients with bacterial meningitis and may help in predicting the outcome of the disease.

Adult↗
PubMed1987

Correlation of cerebral perfusion pressure and Glasgow Coma Scale to outcome.

Cerebral Perfusion Pressures (CPP) and Glasgow Coma Scale (GCS) scores were monitored to guide the management of severely head-injured patients. These measures were correlated to outcome (Glasgow Outcome Scale-GOS) in 136 consecutive patients at least 1 year after injury. The GOS showed highly significant positive correlations to either CPP or GCS assessments (p less than 0.001). Two parameters that are correlated with subsequent death in most patients include 1) highest (h) GCS = 3 or 4 (Day 1: 31 of 32 patients died, and Day 2: 19 of 19 patients died), and 2) CPP less than or equal to 60 mm Hg more than 33% of the hourly measures during Day 2 (36% of all subsequent deaths; 11% overlap with the highest Glasgow Coma Scale). The Day 2 measures identifying two groups that have a greater than 75% incidence of "good outcome" or GOS = 4 or 5 include 1) hGCS greater than or equal to 6 (N = 45) and 2) the average (a) CPP greater than or equal to 90 mm Hg (N = 26). Of the 45 patients with a GOS = 4 or 5 who had both CPP and GCS recorded on the third day, 44 were identified by these "good outcome" parameters.

Blood Pressure↗
PubMed1993

[Use of the Glasgow Coma Scale in pediatric craniocerebral trauma].

Over five years the applicability of a modified Glasgow Coma Scale was analysed in 38 children (mean age 7.2 +/- 3.8 years) with head and associated injuries (47.4%). The score was estimated after the accident and in the course of intensive therapy. At the beginning of the treatment on the intensive care unit, the cases were staged according to the severity of the head injuries (Glasgow Coma Scale: 4-8, 9-12 and 13-19 points). At the stage evaluated as between 4 and 8 points, 50% of the patients died and the survivors were ventilated (11.7 +/- 10.7 days) and intensively treated (45.7 +/- 31.5 days). All patients had had neurological damage. Additional injuries worsened the prognosis in the acute phase. 42.9% of the patients received intracranial pressure monitoring. In the patients between 9 and 12 points, the time of ventilation (3.7 +/- 2.9 days) and of intensive therapy (19.5 +/- 13.3 days) decreased. Over 13 points, all patients had a shorter duration of treatment (10.8 +/- 8.8 days) and a quick and good recovery. The Glasgow Coma Scale has the advantage of an examination with a quantitative analysis and resulting effective diagnostic and therapeutic measures. Even the inexperienced physician can use the Glasgow Coma Scale with success at the site of the accident.

Adolescent↗