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Should the Glasgow Coma Scale Be Abandoned ?

According to an editorial published yesterday in the Annals of Emergency Medicine, the Glasgow Coma Scale (GCS), which is used to assess the extent of brain injury in hospital emergency departments and at the scene of an accident is unreliable, hard to remember and too non-specific to be useful for emergency patients.

The scale provides point values to different levels of observed physical and cognitive functions which are assigned point values.  A score of 3 is the worst score that can be obtained and a score of 15 is the best. Based upon this criteria, the patient is then placed in one of three categories, mild brain injury, moderate brain injury or severe brain injury. 

The scale has been misused to predict long term prognosis and in particular, in the area of mild traumatic brain injury to conclude that a score of "15" translates into no brain injury or cognitive damage which is an unfair use of the grading system.

"The Glasgow Coma Scale (GCS) is obsolete within acute care medicine," said the editorial's author, Steven M. Green, MD, FACEP of Loma Linda University in Loma Linda, Calif. "The GCS should be abandoned in the emergency department and pre hospital settings altogether. There are other, better ways to assess trauma patients, such as SMS or TROLL, which stands for Test responsiveness: obeys, localizes or less."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society.

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