Citation

Fitzgerald M, Tan T, Rosenfeld JV, Noonan M, Tee J, Ng E, Mathew J, Broderick S, Kim Y, Groombridge C, Udy A, Mitra B. Emerg. Med. Australas. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/1742-6723.13937

PMID

35220682

Abstract

The wide-spread use of an initial 'Glasgow Coma Scale (GCS) 8 or less' to define and dichotomise 'severe' from 'mild' or 'moderate' traumatic brain injury (TBI) is an out-dated research heuristic that has become an epidemiological convenience transfixing clinical care. Triaging based on GCS can delay the care of patients who have rapidly evolving injuries. Sole reliance on the initial GCS can therefore provide a false sense of security to caregivers and fail to provide timely care for patients presenting with GCS greater than 8. Nearly 50 years after the development of the GCS - and the resultant misplaced clinical and statistical definitions - TBI remains a heterogeneous entity, in which 'best practice' and 'prognoses' are poorly stratified by GCS alone. There is an urgent need for a paradigm shift towards more effective initial assessment of TBI.

Language: en

Keywords

Glasgow Coma Scale; acute brain injury; triage