TY - JOUR
AU - Stahel, P F
AB - The Glasgow Coma Scale (GCS) was first described in 1974 in a landmark article1 in The Lancet by Sir Graham Teasdale and one of the pioneers of modern neurosurgery, Professor Bryan Jennett. Nowadays, the GCS represents one of the most widely implemented clinical scoring systems, incontestably used in every hospital around the world. The scale was initially described to reflect the depth and duration of impaired consciousness and coma for a diversity of acute insults to the brain, related to trauma, vascular, septic and metabolic disorders. 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. The present study by Hoffmann and colleagues confirms the longstanding notion that the individual motor response component, in conjunction with assessment of pupil reactivity, outweighs the summarized GCS score in predicting outcome in a large cohort of 24 115 patients with TBI from the German Trauma Registry. Notably, Teasdale and Jennett themselves questioned the validity of the summarized use of the three components of the GCS5. The letter unequivocally states that ‘… the information conveyed by the coma score is less than that contained in the three responses separately. (…) Indeed, in Glasgow, patients under treatment are always described by the three separate responses, and never by the total’5. It is time to convey this historic message more globally. Disclosure The author declares no conflict of interest. References 1 Teasdale G , Jennett B. Assessment of coma and impaired consciousness. A practical scale . Lancet 1974 ; 13 : 81 – 84 . Google Scholar OpenURL Placeholder Text WorldCat 2 Namiki J , Yamazaki M, Funabiki T, Hori S. Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians . Clin Neurol Neurosurg 2011 ; 113 : 393 – 398 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Grote S , Böcker W, Mutschler W, Bouillon B, Lefering R. Diagnostic value of the Glasgow Coma Scale for traumatic brain injury in 18 002 patients with multiple injuries . J Neurotrauma 2011 ; 28 : 527 – 534 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Kung WM , Tsai SH, Chiu WT, Hung KS, Wang SP, Lin JW et al. Correlation between Glasgow coma score components and survival in patients with traumatic brain injury . Injury 2010 ; [Epub ahead of print]. Google Scholar OpenURL Placeholder Text WorldCat 5 Teasdale G , Jennett B, Murray L, Murray G. Glasgow Coma Scale: to sum or not to sum? Lancet 1983 ; 2 : 678 . Google Scholar PubMed OpenURL Placeholder Text WorldCat Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - 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)
JO - British Journal of Surgery
DO - 10.1002/bjs.7709
DA - 2011-12-22
UR - https://www.deepdyve.com/lp/oxford-university-press/pupil-evaluation-in-addition-to-glasgow-coma-scale-components-in-aGHf3qomxR
SP - 131
EP - 131
VL - 99
IS - Supplement_1
DP - DeepDyve
ER -