The Glasgow Coma Scale at 40 years: standing the test of time

The Personal View is published on the 40th anniversary of the Glasgow Coma Scale's introduction in a 1974 Lancet article*. Since this seminal publication, the Glasgow Coma Scale has provided a practical method for bedside assessment of impairment of conscious level, the clinical hallmark of acute brain injury. The paper's lead author is Professor Graham Teasdale, of the University of Glasgow, UK, one of the authors of the original paper introducing the scale. Professor Teasdale and colleagues examine the extent to which the original aspirations of the authors have been fulfilled, address some myths and misapprehensions about the scale, examine criticisms, and outline the continuing role of the scale in research and clinical practice.

The scale was designed to be easy to use in clinical practice in general and specialist units and to replace previous ill-defined and inconsistent methods. 40 years later, the Glasgow Coma Scale has become an integral part of clinical practice and research worldwide. Findings using the scale have shown strong associations with those obtained by use of other early indices of severity and outcome. However, predictive statements should only be made in combination with other variables in a multivariate model. Individual patients are best described by the three components of the coma scale; whereas the derived total coma score should be used to characterise groups. Adherence to this principle and enhancement of the reliable practical use of the scale through continuing education of health professionals, standardisation across different settings, and consensus on methods to address confounders will maintain its role in clinical practice and research in the future.