Diagnosing level of consciousness: The limits of the Glasgow coma scale total score

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J89304

Journal:

Journal of Neurotrauma

Year, Volume, Issue, Page(s):

2021 , 38, 23, 3295-3305

Publication Website:

Abstract:

Study investigated the relationship between Glasgow Coma Scale (GCS) total scores and level of consciousness in patients with traumatic brain injury (TBI). The GCS total score aims to reflect severity of injury, with scores of 3–8 indicating a severe injury, 9–12 a moderate injury, and 13–15 a mild injury. A total of 2,455 adults were assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACKTBI) study. Each GCS subscale score combination was assigned a level-of-consciousness rating based on published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state. The findings are presented using summary statistics and four illustrative cases. Participants had the following characteristics: mean age 41.9 years, 69 percent male, initial GCS 3–8 = 13 percent; 9–12 = 5 percent; 13–15 = 82 percent. All GCS total scores between 4–14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7–11. Further, a wide range of total scores was associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3–6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity.

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