Commentary on: Jennett, B.,Bond, M., Assessment of outcome after severe brain damage.. Lancet 1(7905): 480 - 484, 1975

Keywords: grading system, outcome, head injury, quality of life, traumatic brain injury

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     This paper''''s goal was to develop a clear, objective scale to assess outcome after head injury that was not overly optimistic and allowed accurate evaluation of early management. The scale sought to correct previously vague and overly optimistic scales and to evaluate effectiveness of early management strategies.
     expert opinion
     This scale was initially described for patients suffering from traumatic brain injury but is now used in other clinical contexts.
     This paper describes the Glasgow outcome scale which is as follows: 1-death 2-persistent vegetative state 3-severe disability (dependent for daily support) 4-moderate disability (independent for daily life)  5-good recovery (normal life, may have deficits)
     The scale is complicated by prolonged time scale over which recovery may occur. For example, many thought to never work again at 3 years are working at 11 years. The paper also provides some insight on the timing and degree of recovery after traumatic brain injury. Notable examples include: (1) over 1/3 of patients severely disabled at 3 months improved to moderate disability by 1 year, but none showed good recovery, (2) over 1/3 of patients moderately disabled at 3 months were good by 1 year, and (3) all patients with over 3 weeks post-traumatic amnesia had persisting mental handicap of some degree.


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