Discuss the use of the Glasgow Coma Scale (GCS) in patients with traumatic brain injury in your practice and outline its limitations.
(There is no need to document the components of the GCS)
The GCS is a neurological scoring system used to assess conscious level after head injury. It is now usually scored out of 15 and is comprised of 3 categories, best eye response, best vocal response and best motor response. It has recently been used to categorise traumatic brain injury into mild, moderate and severe.
It is the most widely recognised of all conscious level scoring systems in the world. It is quick and reproducible. It is skewed towards motor score, which is good since this is the most reliable measure of short-term prognosis in TBI. The distinction between a motor score of 2, 3 and 4 is a very useful clinical indicator of the severity of TBI, and the area of brain function that has been affected.
Controversy in the literature
How I use GCS in my practice.
The college answer is fairly comprehensive.
A thorough discussion of the advantages and disadvantages of the GCS can be found elsewhere.
It forms a part of the greater topic, the Assessment of the Unconscious Patient.
In brief, the major disadvantages are:
The article by Green (2011) is the definitive resource on this topic, as it is a comprehensive review, in spite of being one person's opinion.
Green, Steven M. "Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale." Annals of emergency medicine 58.5 (2011): 427-430.
Gill, Michelle R., David G. Reiley, and Steven M. Green. "Interrater reliability of Glasgow Coma Scale scores in the emergency department." Annals of emergency medicine 43.2 (2004): 215-223.
Riechers, Ronald G., et al. "Physician knowledge of the glasgow coma scale."Journal of neurotrauma 22.11 (2005): 1327-1334.