title: Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology.
abstract: OBJECTIVE
  Narrative review of Glasgow Coma Scale (GCS) methodology.
  
  
  METHODS
  Narrative review of published papers describing methodological aspects of the GCS, from Premedline, Medline, EMBASE, CINAHL and Ovid Nursing databases from 1950 to May 2012.
  
  
  RESULTS
  Examination of 18,851 references limited to descriptions of GCS development, pathophysiological correlations, examination techniques, complications or clinician agreement gave a final set of 33, which were summarised in this review.
  
  
  CONCLUSIONS
  The GCS was designed for the objective measurement of level of consciousness, assessment of trend, and to facilitate accurate and valid communication between clinicians. Concerns have been raised about the potential for misleading levels of precision engendered by the use of the GCS, and the use of simpler scales suggested. This review discusses the GCS and conditions affecting calculation of domain and summary scores, and recommends a method of implementation and interpretation.
authors.affiliation: NSW Institute of Trauma and Injury Management, Australia. pmmiddleton@gmail.com
authors.forename: Paul M
authors.initials: PM
authors.lastname: Middleton
mesh_terms: D001925:Brain Damage, Chronic / Q000145:classification* / Q000175:diagnosis; D003128:Coma / Q000145:classification* / Q000175:diagnosis; D003244:Consciousness Disorders / Q000145:classification* / Q000175:diagnosis; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014474:Unconsciousness / Q000145:classification