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Glasgow Coma Scale, mental status measurement tool found unreliable

Armen Hareyan's picture

The undisputed universal measurement tool for mental status assessment, the Glasgow Coma Scale, is unreliable, hard to remember and too non-specific to be useful for emergency patients, according to an editorial published online yesterday in Annals of Emergency Medicine. The editorial accompanies a study comparing the Glasgow Coma Scale to the Simplified Motor Score (SMS) for predicting outcomes for traumatic brain injury patients in the out-of-hospital setting ("Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale" and "Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes Following Traumatic Brain Injury").

Expert says The Glasgow Coma Scale is obsolete

"The Glasgow Coma Scale (GCS) is obsolete within acute care medicine," said the editorial's author, Steven M. Green, MD, FACEP of Loma Linda University in Loma Linda, Calif. "The GCS should be abandoned in the emergency department and prehospital settings altogether. There are other, better ways to assess trauma patients, such as SMS or TROLL, which stands for 'Test responsiveness: obeys, localizes or less'."

Traumatic brain injury is the leading cause of death and disability among children and young adults in the United States. Approximately 1.7 million people sustain a traumatic brain injury each year in the United States, which costs an estimated $60 billion a year. The Glasgow Coma Score was developed in 1974 to assess and manage traumatic brain injury, but has morphed into a screening tool for patients with and without traumatic brain injury. Dr. Green's editorial says it "predicts mortality well at its extremes and poorly in its mid-range" but "fails to meet the standards of modern evidence-based medicine."

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Dr. Green's editorial responds to a study of 19,408 patient records, which showed little difference between the GCS and the SMS for predicting outcomes in traumatic brain injury in the out-of-hospital setting. The SMS was actually more accurate than the GCS in predicting mortality.

"Our study confirmed earlier studies showing that in the chaotic prehospital environment, the 13-point GCS is unnecessarily complex and should be replaced by the three-point SMS," said lead study author David Thompson, MD, MPH of Denver Health Medical Center in Colo.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society.

Written by Julie Lloyd
American College of Emergency Medicine