title: The use of Glasgow Coma Scale in injury assessment: a critical review.
abstract: OBJECTIVE
  Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluates the use of GCS scoring in medical literature and identifies the reasons for inaccuracy. LITERATURE SELECTION AND CRITICAL APPRAISAL: Pubmed and ISI Web of Knowledge SM were searched using specific keywords. The authors critically appraised the current state of GCS scoring, GCS definitions, the time and frequency of assessment, confounders, GCS reporting and GCS assessment schemes.
  
  
  RESULTS
  More than 90% of the publications using GCS scoring cite the 14-item GCS rather than the 15-item GCS. The timing of the initial GCS assessment is inconstant. GCS components are seldom utilized, contributing to the loss of information. Confounders are often not reported and, if they are, not in a standardized manner. The order of the GCS components is not consistent.
  
  
  CONCLUSIONS
  The current inconsistent and inappropriate use of GCS diminishes its reliability in both a clinical and a scientific context. A consensus statement is needed to correct this situation. Citing the correct references, early and repeated GCS assessments at defined intervals, standardized reporting of confounders and GCS component plus sum scores, and the utilization of a uniform assessment scheme are recommended.
authors.affiliation: Department of Anaesthesia & Intensive Care, University Hospital Basel, Basel, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Zuercher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ummenhofer
authors.forename: Anja
authors.initials: A
authors.lastname: Baltussen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Walder
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards; D015600:Glasgow Coma Scale / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008503:Medical Staff; D011379:Prognosis; D015203:Reproducibility of Results; D013337:Students, Medical