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Review Article

Glasgow coma scale: what is new?

Sujan Narayan Agrawal.


Traumatic brain injury (TBI) is one of the most devastating types of injury, and it affects all ages. In India as per the report of the ministry of road transport, Government of India (2007) 1.4 lakhs road accident happened in 2007 with 40,612 people killed and 1.5 lakhs people injured.[1] The frequency of head injury in the UK is around 1500 cases per 100,000 populations per year. Annual mortality attributable to head injury is estimated at 9 per 100,000 and it remains the leading cause of death and disability.
In traumatic brain injury, assessment of the patient’s clinical condition and that of secondary changes by using the Glasgow coma scale constitute the mainstay of TBI management. It is a helpful tool not only for quantifying the injury but also to prognosticate. It evaluates verbal response, eye-opening and motor response in a patient with TBI. The new dimensions added to this time-tested scale are the result of the CRASH (Corticosteroid Randomisation After Significant Head Injury) and IMPACT (International Mission for Prognosis and Clinical Trials in TBI) studies.
These new parameters are the reaction of a pupil to light, Age and CT scan findings. The pupillary response is the key indicator of the severity of traumatic brain damage. It is recorded as both pupil reacting to light, one pupil reacting to light or no reaction. The information is combined using a simple arithmetic score (GCS score [range3-15]) minus the number of non-reacting pupils [0, 1, or 2]. It has also been observed that as the age advances (in patients with TBI), the prognosis becomes poorer. The patient’s age and GCS-P have an additive effect on the outcome. The probability of mortality and unfavourable recovery, six months after neurotrauma is greater with increasing age. Analysis of CT findings showed that differences in outcome are very similar between patients with or without a hematoma, absent cistern or subarachnoid hemorrhage. The information gained by CT findings has an added value over GCS-P and age alone. It is a simple extension of the original chart by adding these three abnormal CT findings i.e. none, only 1, and 2 or more CT abnormalities.
The important prognostic features in a patient with neurotrauma can be brought to gather with graphical display. It helps the clinician to support the decision making and to evaluate the risk of good or poor outcome. It also improves the communication of risk among health care professionals, patients, and their relatives.

Key words: Glasgow coma scale, neurotrauma, prognosis, papillary reaction, traumatic brain injury

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