Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale.
نویسنده
چکیده
It is time to abandon the Glasgow Coma Scale (GCS). As discussed below, this ubiquitous neurologic scoring system is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound. Teasdale and Jennett devised the GCS in 1974 not for acute care, but rather for the “repeated bedside assessment” in a neurosurgical unit to detect “changing states” of consciousness and to measure the “duration of coma.” They never intended for its elements to be assigned numeric scores or for its 3 subscales to be merged or totaled. Yet, despite their objections both such dubious modifications subsequently proved irresistible to the medical community. The quantitative GCS subsequently has become the undisputed universal criterion standard for mental status assessment and is thus a fundamental part of the culture of emergency medicine, out-of-hospital care, trauma surgery, and neurosurgery. This scale is a core component of prominent trauma and life support courses, and in most of the developed world out-of-hospital care providers routinely assess the GCS for each patient with trauma or altered mental status. The original GCS article has been cited almost 6,000 times. This editorial outlines the potent limitations of the GCS and why it should now be considered obsolete within acute care medicine. This scale might be useful, however, for detecting subtle neurologic changes over time in an ICU (as originally envisaged). Curiously, though, it has never been validated for this separate role.
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ورودعنوان ژورنال:
- Annals of emergency medicine
دوره 58 5 شماره
صفحات -
تاریخ انتشار 2011