The prognostic value of the components of the Glasgow Coma Scale following acute stroke.
BACKGROUND
The Glasgow Coma Scale (GCS) is widely used in assessing level of consciousness. The GCS verbal component may be misleading in acute stroke: a focal neurological deficit leading to dysphasia could affect the score, independently of level of consciousness.


OBJECTIVE
To investigate the relationship, in all strokes and in dysphasic patients, between stroke outcome and total GCS (with and without the verbal score) and its components, to assess their relative values.


METHODS
Retrospective analysis following prospective data collection in an acute stroke unit and follow-up.


METHODS
Outcomes studied were 2-week mortality and 3-month recovery (survival, subject living at home). We used area under the receiver operating characteristic curve (AUC) to compare versions of the GCS and multivariate logistic regression to identify which subset of GCS components best predicted outcome.


RESULTS
Of 1517 patients with acute stroke, 1217 had complete clinical and follow-up data; 349 were dysphasic. Total GCS had greater AUC than the GCS without the verbal score, for mortality (all patients 0.78 vs. 0.76, p=0.021; dysphasics 0.72 vs. 0.71, p=0.52) and recovery (all patients 0.71 vs. 0.67, p=0.0001; dysphasics 0.74 vs. 0.70, p=0.055). Verbal and eye scores independently provided prognostic information, for each patient group and outcome measure.


CONCLUSIONS
The GCS contains valuable predictive information. Regardless of whether dysphasia is present, the verbal score should be assessed since it adds prognostic information to that from the eye component, and has greater value than the motor score.
Weir
C J
CJ
Department of Medicine and Therapeutics, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, Scotland, UK. c.j.weir@clinmed.gla.ac.uk
Bradford
A P J
AP
Lees
K R
KR
D000368:Aged; D001037:Aphasia / Q000175:diagnosis; D004812:Epidemiologic Methods; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000523:psychology; D016019:Survival Analysis; D016896:Treatment Outcome; D014705:Verbal Behavior