title: The Glasgow Coma Scale and evidence-informed practice: a critical review of where we are and where we need to be.
abstract: OBJECTIVE
  This paper aims to critically consider the evidence since the Glasgow Coma Scale was first launched, reflecting on how that evidence has shaped practice. It illustrates the lack of clarity and consensus about the use of the tool in practice and draws upon existing evidence to determine the route to clarity for an evidence-informed approach to practice.
  
  
  BACKGROUND
  The Glasgow Coma Scale has permeated and influenced practice for over 40 years, being well-established worldwide as the key tool for assessing level of consciousness. During this time, the tool has been scrutinised, evaluated, challenged and re-launched in a plethora of publications. This has led to an insight into the challenges, and to some extent the opportunities, in using the Glasgow Coma Scale in practice but has also resulted in a lack of clarity.
  
  
  METHODS
  This is a discursive paper that invites readers to explore and arrive at a more comprehensive understanding of the Glasgow Coma Scale in practice and is based on searches of Scopus, Web of Knowledge, PubMed, Science Direct and CINAHL databases.
  
  
  RESULTS
  While the Glasgow Coma Scale has been rivalled by other tools in an attempt to improve upon it, a shift in practice to those tools has not occurred. The tool has withstood the test of time in this respect, indicating the need for further research into its use and a clear education strategy to standardise implementation in practice.
  
  
  CONCLUSIONS
  Further exploration is needed into the application of painful stimuli in using the Glasgow Coma Scale to assess level of consciousness. In addition, a robust educational strategy is necessary to maximise consistency in its use in practice.
  
  
  CONCLUSIONS
  The evidence illustrates inconsistency and confusion in the use of the Glasgow Coma Scale in practice; this has the potential to compromise care and clarity around the issues is therefore necessary.
authors.affiliation: School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, Salford, UK.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Braine
authors.affiliation: School of Nursing, Ulster University, Londonderry, UK.
authors.forename: Neal
authors.initials: N
authors.lastname: Cook
mesh_terms: D003244:Consciousness Disorders / Q000175:diagnosis* / Q000451:nursing; D055318:Evidence-Based Nursing; D015600:Glasgow Coma Scale; D006801:Humans; D057184:Practice Patterns, Nurses' / Q000639:trends*
keywords: Glasgow Coma Scale; eye opening response; motor response; neurological assessment; painful stimuli