@article{ref1,
title="Lack of standardization in the use of the Glasgow Coma Scale. Results of international surveys",
journal="Journal of neurotrauma",
year="2015",
author="Reith, Florence C. M. and Brennan, Paul M. and Maas, Andrew and Teasdale, Graham M.",
volume="33",
number="1",
pages="89-94",
abstract="The Glasgow Coma Scale (GCS) was introduced 40 years ago and has received worldwide acceptance. The GCS rates eye, motor and verbal responses to assess the level of consciousness. Concerns have been expressed with regard to reliability and consistency of assessments. We considered that lack of standardization in application techniques and reporting of the GCS may have contributed to these concerns, and aimed to assess current procedures in its use. Questionnaire-based assessments were conducted via an on-line survey and during neurosurgical training courses. Overall, 616 participants were recruited, representing 48 countries and including physicians and nurses from different disciplines. Use of the GCS was reported by nearly all participants for assessment of patients with traumatic brain injury, but not for all patients with a reduced level of consciousness from other causes (78%). Major differences were found regarding the type of stimulus applied when patients do not obey commands: nail bed pressure, supra-orbital pressure, trapezius or pectoralis pinch and sternal rub were all frequently used. 25% percent of responders reported to never use a peripheral stimulus. Strategies for reporting the GCS varied greatly and 35% of participants limited the reporting to a summary score. Moreover, different approaches were used when one of the components could not be assessed. Overall, the surveys have identified a general lack of standardization in assessment and reporting of the GCS. The results illustrate the need for continued education to improve reliability of assessments through guidance to a standard approach. Key words: Consciousness, Glasgow Coma Scale, Humans, Questionnaires, Reproducibility of results.<p /> <p>Language: en</p>",
language="en",
issn="0897-7151",
doi="10.1089/neu.2014.3843",
url="http://dx.doi.org/10.1089/neu.2014.3843"
}