[en] In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured
using the Glasgow Coma Scale (GCS) total score. The GCS total score however, may not accurately reflect
level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS
total scores and level of consciousness in a consecutive sample of 2455 adult subjects assessed with the
GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACKTBI) study. We assigned each GCS subscale score combination a level of consciousness rating based on published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/
unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3–8 = 13%; 9–12 = 5%; 13–15 = 82%.
All GCS total scores between 4–14 were associated with more than one DoC diagnosis; the greatest variability
was observed for scores of 7–11. Further, a wide range of total scores was associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3–6. The GCS total score does
not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should
consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity
Research Center/Unit :
GIGA-COMA - GIGA Consciousness-Coma Science Group - ULiège CHU de Liège-Centre du Cerveau² - ULiège
Disciplines :
Neurology
Author, co-author :
Bodien, Yelena G ✱; Massachussetts General Hospital > Spaulding Rehabilitation Hospital, > Neurorehabilitation Lab > Associate researcher
Barra, Alice ✱; Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
✱ These authors have contributed equally to this work.
Language :
English
Title :
Diagnosing Level of Consciousness: Limits of the Glasgow Coma Scale Total Score
Publication date :
23 November 2021
Journal title :
Journal of Neurotrauma
ISSN :
0897-7151
eISSN :
1557-9042
Publisher :
Mary Ann Liebert, United States - New York
Volume :
38
Peer reviewed :
Peer Reviewed verified by ORBi
Name of the research project :
TRACK-TBI
Funders :
NINDS - National Institute of Neurological Disorders and Stroke NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research ACL - Administration for Community Living JSMF - James S McDonnell Foundation Tiny Blue Dot Foundation USDOD - United States Department of Defense NSF - National Science Foundation
Funding text :
This study was supported by the NIH National Institute of Neurological Disorders and Stroke (R21NS109627, RF1NS115268, UH3NS095554, U01 NS1365885, U01- NS086090), NIH Director’s Office (DP2 HD101400), National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), Administration for Community Living (90DPCP0008-01-00, 90DP0039), James S. McDonnell Foundation, and Tiny Blue Dot Foundation, U.S. Department of Defense (W81XWH14-2-0176, X81XWH-18-DMRDP-PTCRA), National Science Foundation (1014552)
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