The Glasgow Coma Scale: 50-year anniversary.

In 1974, Sir Graham Teasdale and Bryan Jennett wrote the "Assessment of coma and impaired consciousness, A practical scale," which has become one of the most influential papers in the history of traumatic brain injury, with more than 10,000 citations as of January 2024. Today, it is one of the most widely used tools in emergency departments, providing a reliable general overview of the patient's consciousness status.

The Story of the Development and Adoption of the Glasgow Coma Scale: Part I, The Early Years.

The Glasgow Coma Scale and its derived Score have been adopted worldwide for assessing the degree of impaired responsiveness in traumatic brain injury and other kinds of acute brain damage. In this historical vignette, we describe how the foundations for their enduring success were laid during their initial development. To provide a unique additio nal background and context, the material from interviews with one of the originators of the scale was brought together with information from key publications in the early years after the first description of the scale in 1974. This historical investigation shows how the contents of the eye, verbal, and motor components of the scale were assembled through analysis of previous systems, guided by early clinimetric principles. Its reproducibility as a tool for clinical communication was confirmed through innovative studies of interobserver variability. To test its validity, international collaborations linking units in Britain, the Netherlands, and the United States were pursued. These collaborations were accompanied by the creation of the total Glasgow Coma Score with a 6-point motor subdivision. The observation that outcomes after severe head injury were similar in the different countries, despite marked variations in management, stimulated controversy that promoted further interest in traumatic brain injury research and a recommendation for the worldwide use of the scale as a common severity marker. Inclusion of the scale in major developments such as the Advanced Trauma Life Support (ATLS) and the National Traumatic Coma Databank cemented its influential position in clinical care and research for the succeeding decades.

Classification of traumatic brain injury: past, present, and future.

Disease classification is central to the practice of medicine; it systematizes clinical knowledge and experience. Classification is essential for diagnosis and effective treatment of human disease. Progress in classifying traumatic brain injury (TBI) for targeted treatment has lagged behind other diseases such as cancer, and has contributed to a lack of progress in the field. Today TBI is most frequently classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS). However, the GCS is symptoms-based and does not allow for targeting of specific pathology. Here we review general schemas for disease classification and how they have evolved over time. We discuss the characteristics of an ideal classification system and the unique challenges inherent to achieving such a system for TBI. Current means of classifying TBI are reviewed, as are the strengths and limitations of these approaches. Generating the data required to modernize TBI classification and to perhaps facilitate a targeted, precision medicine approach to its management will require a highly collaborative international effort. Fortunately these efforts are underway and will benefit from the lessons and tools that have come from other areas of medicine that have already found success with this approach.

Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score.

The Glasgow Coma Scale (GCS) has been the gold standard for assessing the level of consciousness in patients with significant brain injury. Prior efforts to modify or replace this scale have been unsuccessful because no scale could improve on its simplicity and practical usefulness. This review provides a historical perspective on coma scales and introduces a new and simple, but more comprehensive, scale: the Full Outline of UnResponsiveness (FOUR) Score, which has been recently validated. The FOUR Score has 4 components with "4" as a maximal score for each item. The individual components are eye responses (eye opening and eye tracking), motor responses (responses to pain and following simple hand commands), brainstem reflexes (pupil, cornea, and cough reflexes), and respiration (breathing rhythm and respiratory drive in ventilated patients). The FOUR Score is a further improvement on previous scales for classifying and communicating impaired consciousness.

The history of the Glasgow Coma Scale: implications for practice.

The Glasgow Coma Scale (GCS) has been the gold standard of neurologic assessment for trauma patients since its development by Jennett and Teasdale in the early 1970s. The GCS was found to be a simple tool to use. It became the method of choice for trauma care practitioners to document neurologic findings over time and predict functional outcome. Although the scale has been shown to be effective, many authors have cited weaknesses in the scale including the inability to predict outcome, variation in inter-rater reliability, and the inconsistent use by caregivers in the prehospital and hospital settings. This article outlines the components of the GCS and how practitioners can best use the scale, particularly in patients whose injuries and treatments make them difficult to assess.