Commentary on: Teasdale, G.,Jennett, B., Assessment of coma and impaired consciousness. A practical scale.. Lancet 2(7872): 81 - 84, 1974Zaman Mirzadeh, MD, PhD1, Rami O Almefty, MD1, Peter Nakaji, MD11Department of Neurosurgery, Barrow Neurological Institute Keywords: coma, Glasgow Coma Score (GCS), critical care, traumatic brain injury, grading systemInteractive ManuscriptAsk Questions of this Manuscript: What questions did this manuscript seek to answer?The authors wanted to generate a scale that could be used repeatedly throughout illness by a range of staff and reliably recorded and understood to assess level of consciousness. Describe the design of this manuscript.expert opinion/review List the inclusion and exclusion criteria for the study population.This question was not answered by the author What were the results of this manuscript?Developed and described the GCS scale, rating 3 variables in order to determine level of consciousness:
eye opening: E4=spontaneous, E3=to speech, E2=to pain, E1=none; verbal response: V5=orientated, V4=confused, V3=inappropriate (no sustained conversation, eg. words only), V2=incomprehensible (eg. sounds, no words), V1=none; motor response: M6=obeys commands, M5=localizes painful stimulus, M4=withdrawal from painful stimulus, M3=flexor response to painful stimulus (note: although in the current GCS scale, withdrawal and flexor responses to pain are graded differently, this paper did not distinguish them in the original scale), M2=extensor response to painful stimulus, M1=no response Highlight any other important points that this manuscript covered.Regarding how differences in motor responses of upper versus lower limbs should be reflected in the overall scale, the paper states: "Any difference between the responsiveness of one limb and another may indicate focal brain damage and for this purpose the worst (most abnormal) response should be noted. But for the purpose of assessing the degree of altered consciousness it is the best response from the best limb that is recorded." Are there any questions or ideas for the future that you would pose to the authors?This question was not answered by the author Please describe how you would improve this report or the research that was done.The authors conducted a validation and inter-rater reliability test of their scale by having various doctors and nurses examine the same group of patients. Unfortunately, these results were never published, and it is only mentioned that disagreements were rare. It would be informative to know exactly in what context disagreements occurred and whether there were systematic albeit small differences in application of the scale between doctors, nurses, and other staff. The authors wanted to generate a scale that could be used repeatedly throughout illness by a range of staff and reliably recorded and understood to assess level of consciousness. expert opinion/review Developed and described the GCS scale, rating 3 variables in order to determine level of consciousness:
eye opening: E4=spontaneous, E3=to speech, E2=to pain, E1=none; verbal response: V5=orientated, V4=confused, V3=inappropriate (no sustained conversation, eg. words only), V2=incomprehensible (eg. sounds, no words), V1=none; motor response: M6=obeys commands, M5=localizes painful stimulus, M4=withdrawal from painful stimulus, M3=flexor response to painful stimulus (note: although in the current GCS scale, withdrawal and flexor responses to pain are graded differently, this paper did not distinguish them in the original scale), M2=extensor response to painful stimulus, M1=no response Regarding how differences in motor responses of upper versus lower limbs should be reflected in the overall scale, the paper states: "Any difference between the responsiveness of one limb and another may indicate focal brain damage and for this purpose the worst (most abnormal) response should be noted. But for the purpose of assessing the degree of altered consciousness it is the best response from the best limb that is recorded."
The authors conducted a validation and inter-rater reliability test of their scale by having various doctors and nurses examine the same group of patients. Unfortunately, these results were never published, and it is only mentioned that disagreements were rare. It would be informative to know exactly in what context disagreements occurred and whether there were systematic albeit small differences in application of the scale between doctors, nurses, and other staff.
The Author(s) wish to thank:Project Roles:
Z. Mirzadeh (Performed Research), R. Almefty (Performed Research), P. Nakaji (Performed Research)
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