title: The Glasgow Coma Scale at 40 years: standing the test of time.
abstract: Since 1974, the Glasgow Coma Scale has provided a practical method for bedside assessment of impairment of conscious level, the clinical hallmark of acute brain injury. The scale was designed to be easy to use in clinical practice in general and specialist units and to replace previous ill-defined and inconsistent methods. 40 years later, the Glasgow Coma Scale has become an integral part of clinical practice and research worldwide. Findings using the scale have shown strong associations with those obtained by use of other early indices of severity and outcome. However, predictive statements should only be made in combination with other variables in a multivariate model. Individual patients are best described by the three components of the coma scale; whereas the derived total coma score should be used to characterise groups. Adherence to this principle and enhancement of the reliable practical use of the scale through continuing education of health professionals, standardisation across different settings, and consensus on methods to address confounders will maintain its role in clinical practice and research in the future.
authors.affiliation: Mental Health and Wellbeing, Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. Electronic address: graham.teasdale@glasgow.ac.uk.
authors.forename: Graham
authors.initials: G
authors.lastname: Teasdale
authors.affiliation: Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
authors.forename: Andrew
authors.initials: A
authors.lastname: Maas
authors.affiliation: Emergency Medicine Research in Sheffield, Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Manley
authors.affiliation: Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Nino
authors.initials: N
authors.lastname: Stocchetti
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Murray
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology; D015600:Glasgow Coma Scale / Q000592:standards* / Q000639:trends*; D006801:Humans; D011237:Predictive Value of Tests; D013997:Time Factors