Understanding and application of the glasgow coma scale amongst health care professionals caring for patients with traumatic head injury

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients.

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A study on correlation of degree of midline shift on CT scan and Glasgow coma scale in patients of acute traumatic head injury

International Journal of Research in Medical Sciences ◽

10.5455/2320-6012.ijrms20140877 ◽

2014 ◽

Vol 2 (3) ◽

pp. 1063

Author(s):

Akhilesh Ratnakar

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Ct Scan ◽

Midline Shift ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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Correlation Between Brain Imaging and Glasgow Coma Scale in Traumatic Head Injury in Pediatrics

International Journal of Medical Imaging ◽

10.11648/j.ijmi.20150303.14 ◽

2015 ◽

Vol 3 (3) ◽

pp. 63

Author(s):

Mohamed Labib Ahmed El Moghier

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Brain Imaging ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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A STUDY ON CORRELATION OF DEGREE OF MIDLINE SHIFT ON CT SCAN AND GLASGOW COMA SCALE IN PATIENTS OF ACUTE TRAUMATIC HEAD INJURY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i8.1371 ◽

2020 ◽

Vol 4 (8) ◽

Author(s):

Sandeep Kumar ◽

Narendra Kumar Kardam ◽

Kushal babu Gahlot ◽

Manphhol Singh Maharia

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Ct Scan ◽

Subdural Hematoma ◽

Midline Shift ◽

Extradural Hematoma ◽

Traumatic Head Injury ◽

Coma Scale ◽

Depressed Fracture ◽

Traumatic Head

Background: The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Results: External injury of scalpel is seen in 92% of cases, blackening of eye in 50% & vomiting in 50%. Cerebral contusion (50%) was the most common CT scan finding followed by depressed fracture (32%), subdural hematoma (22%) than extradural hematoma (6%). Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusions: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome. Keywords: CT scan, Glasgow coma scale, acute traumatic head injury.

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Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood

PLoS ONE ◽

10.1371/journal.pone.0082245 ◽

2013 ◽

Vol 8 (12) ◽

pp. e82245 ◽

Cited By ~ 11

Author(s):

Natasha L. Heather ◽

José G. B. Derraik ◽

John Beca ◽

Paul L. Hofman ◽

Rangi Dansey ◽

...

Keyword(s):

Early Childhood ◽

Head Injury ◽

Glasgow Coma Scale ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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Comparison between FOUR score and GCS in assessing patients with traumatic head injury: a tertiary centre study

International Surgery Journal ◽

10.18203/2349-2902.isj20170209 ◽

2017 ◽

Vol 4 (2) ◽

pp. 656 ◽

Cited By ~ 2

Author(s):

Sharath S. Nair ◽

Anilkumar Surendran ◽

Rajmohan B. Prabhakar ◽

Meer M. Chisthi

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Head Injuries ◽

Neurological Status ◽

Initial Assessment ◽

Traumatic Head Injury ◽

Mortality And Morbidity ◽

Coma Scale ◽

Tertiary Centre ◽

Traumatic Head

Background: Head injuries are a major cause of mortality and morbidity across the world. Effective initial assessment and early intervention is of importance in patients with traumatic brain injury, so as to ensure the maximum favorable outcome. Glasgow Coma Scale is the widely accepted scale to assess severity in head injury patients, albeit with many inadequacies. The objective of this study was to test the validity of full outline of unresponsiveness score, an alternate tool, in assessing severity in patients with traumatic brain injury.Methods: This was a descriptive study, conducted on 69 patients admitted to the general surgical and neuro-surgical wards of Government Medical College, Trivandrum, India with traumatic head injury. For all these patients, full outline of unresponsiveness score and Glasgow Coma Scale were calculated at the time of presentation and serially thereafter. The predictive value of full outline of unresponsiveness score as well as its correlation with Glasgow Coma Scale was studied.Results: A statistically significant correlation was found between full outline of unresponsiveness score and Glasgow Coma Scale in estimating the severity of head injury. Also Full Outline of unresponsiveness score was able to furnish better details about the neurological status of trauma patients.Conclusions: As per the results, it can be concluded that the full outline of unresponsiveness score can be applied as an ideal tool to evaluate consciousness levels and patients’ status in patients with traumatic head injury. It can be used as the ideal replacement for Glasgow Coma Scale.

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A study of correlation of degree of midline shift on computed tomography scan and Glasgow coma scale in patients of acute traumatic head injury

International Surgery Journal ◽

10.18203/2349-2902.isj20213998 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3075

Author(s):

A. K. Chaurasia ◽

Lalit Dhurve ◽

Rajneesh Gour ◽

Rajpal Kori ◽

Avias K. Ahmad

Keyword(s):

Computed Tomography ◽

Head Injury ◽

Glasgow Coma Scale ◽

Severe Head Injury ◽

Road Traffic ◽

Midline Shift ◽

Traumatic Head Injury ◽

Cross Sectional ◽

Common Cause ◽

Coma Scale

Background: Traumatic brain injury is one of most common cause of death in road traffic accident. Most of these classified as mild injury, with approximately 20% classified as moderate to severe. Approximate 50% of the 150,000 trauma deaths every year are caused by head injury.Methods: A prospective cross-sectional study was conducted on 150 patients with a head injury admitted in the Hamidia hospital, Bhopal. The assessment of the severity of head injury using Glasgow coma scale (GCS) at the time of admission, follow up on 5 days and 15 days respectively. The collected data were transformed into variables, coded and entered in Microsoft excel. Data were analyzed and statistically evaluated using statistical package for the social sciences (SPSS)-PC-21 version.Results: Out of 150, a total of 115 patients had no midline shift while 35 patients were having midline shift. Severe head injury patients (GCS 3-8) were having more morbidity and mortality. Moderate head injury (GCS 9-13) was associated with good prognosis and low mortality. A greater degree of midline shift of (more than 5 mm) is indicated severe head injury and is significantly associated with morbid outcome and higher mortality.Conclusions: In our study, road traffic accidents is the most common cause of head injury, with males being affected more than females. The degree of midline shift on computed tomography (CT) scan head in patients with head injuries was found to be significantly associated with high mortality and morbidity.

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Simplifying Glasgow Coma Scale Use for Nurses

International Journal of Advanced Nursing Studies ◽

10.14419/ijans.v4i2.4639 ◽

2015 ◽

Vol 4 (2) ◽

pp. 69

Author(s):

Hamza AL-Quraan ◽

Mohannad AbuRuz

Keyword(s):

Health Care ◽

Literature Review ◽

Glasgow Coma Scale ◽

Health Care Providers ◽

Health Care Professionals ◽

Research Literature ◽

Original Research ◽

Care Providers ◽

Gold Standard Method ◽

Coma Scale

Glasgow Coma Scale (GCS) was introduced in 1974 as a tool to standardize the assessment of the level of consciousness of patients. Since it was introduced and used, GCS was considered to be the gold standard method for this purpose. Despite plenty of strengths GCS has (i.e. objectivity and easy communication on the results between the health care providers); GCS was considered to be ambiguous and confusing for nurses and infrequent users. Moreover, lack of knowledge and training about GCS might affect the accuracy and inter-rater reliability among health care professionals. The purpose of this paper was to simplify the use of GCS step by step for the beginner health care professionals.This literature review was done by searching the following search engines: Pubmed, Midline, CINHAL, Ebsco host, and Google Scholar for the key words of: Glasgow Coma Scale (GCS), flow chart, nurses, and consciousness.Types of articles included: original research, literature review and meta-analysis. This review included the following sections:1) Definition of the related concepts2) The historical development of the GCS3) How to score the GCS4) Recommendation for clinical settings, and5) Conclusion

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KORELASI ANTARA NEURON-SPECIFIC ENOLASE SERUM DAN GLASGOW COMA SCALE DI PASIEN CEDERA KEPALA

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v17i1.1043 ◽

2018 ◽

Vol 17 (1) ◽

pp. 25

Author(s):

Usi Sukorini ◽

Isti Setijorini Wulandari ◽

Budi Mulyono ◽

Handoyo Pramusinto

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Brain Damage ◽

Clinical Laboratory ◽

Biochemical Marker ◽

Neuron Specific Enolase ◽

Mild Head Injury ◽

Traumatic Head Injury ◽

Cross Sectional ◽

Coma Scale

The outcome after head injury is mostly determined by Glasgow Coma Scale (GCS) and the degree of brain damage which reveals.CT scan is also important to assess its severity. However relatively it is not in a less costly manner and sometimes patients mobilisationare needed. Brain damage due to traumatic head injury refers to homeostasis unbalance, and it is the important causes of releasingbiochemical analyte from neuron via injured blood brain barrier to circulation. Neuron-specific enolase as a glycolytic enzyme in neuroncytoplasm might increase. Hopefully, measurement of NSE levels can provide information about the extent of the disease. The objectiveof the study is to test the correlation between the Neuron Specific Enolase (NSE) serum as a one of biochemical marker of brain injuryand the GCS. For this purpose, a cross sectional, analytical observasional study was carried out at the Emergency Departement andDepartement of Clinical Laboratory, Sardjito General Hospital, Yogyakarta, Indonesia. Fifty-one patients selected by an eligible criteriawere included in the study, which consist of severe, moderate and mild head injury. Blood samples were collected and serum NSE wasmeasured by immunoanalyzer using Electro Cheluminescence ImmunoAssay (ECLIA). Chi square test was used to test the differenceproportion of the group: NSE ≥ 21.7 ng/mL and NSE < 21.7 ng/mL according to measured variables, and Spearman correlation testwas used to correlate serum NSE and GCS, and other variables. In the study fifty-one patients with head injury were included, 74.5%of patients were males and 68.6% is in the age of 15–45 years old. The patients were further divided into two groups on the basis ofserum NSE ≥ 21.7 ng/mL and < 21.7 ng/mL; the former group was dominated by severe head injury patients (54.1%). In addition, aproportion of non survivors (66.6%) in group NSE ≥ 21.7 ng/mL was higher compared to those in NSE < 21.7 ng/mL group. Moreover,a large number of mild head injury (95.45%) and survivors (83.33%) had lower serum NSE (< 21.7 ng/mL). In the study, was found anegative correlation between serum NSE and GCS (r = -0.552; p = 0.00). Also, serum NSE were inversely correlated with blood kaliumand hemoglobin (r = -0.162; p = 0.027 dan r = -0.376; p = 0.009), in contrast with leucocytes count (r = 0.485; p = 0.001). Theconclusion so far there was a negative correlation between serum NSE and GCS. It is suggested that neuron-specific enolase can be veryuseful as a biochemical marker in assesssing the severity of head injury. Therefore, it is nessessary to carry out the prognostic study toknow to what extent it can predicting the outcomes.

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Full Outline of Unresponsiveness Score versus Glasgow Coma Scale in Assessing Patients with Isolated Traumatic Head Injury

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/202 ◽

2021 ◽

Vol 8 (16) ◽

pp. 1047-1052

Author(s):

Ashok Kumar Nayak ◽

Srikanta Das ◽

Prafullachandra Hoogar

Keyword(s):

Head Injury ◽

Interobserver Reliability ◽

Pearson Correlation ◽

Characteristic Curve ◽

Initial Assessment ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head ◽

Four Score ◽

Time Of Admission

BACKGROUND Traumatic head injury is one of the most common causes of mortality all over the world. Substantial initial assessment of head injury and its intensity in these patients is the primary goal for medical treatment. Hence, there is a necessity for a score better than GCS for the assessment of head injury patients. FOUR score, a new coma scale was published by Wijdicks in 2005. It included 4 components, motor response, eye response, brainstem reflex, and respiration. It precisely assesses the neurological activity as it includes the brain stem reflexes and eliminates the verbal component and identifies locked-in syndromes, temporal lobe herniations and third nerve dysfunctions which GCS fails to do so. We wanted to evaluate the correlation between FOUR score and GCS in evaluating the level of consciousness in patients with head injuries and evaluate the interobserver reliability of both the above-mentioned scores. METHODS This is an observational prospective study conducted on 92 patients with isolated traumatic head injury admitted to Department of General Surgery, VIMSAR, Burla, from November 2018 to October 2020. The parameters that were evaluated were clinical examination at the time of admission, were blood pressure (BP), temperature, pulse, and respiratory rate at the time of admission. Assessment of GCS and FOUR score at the time of admission, at 6 th hour, 24th hour and daily assessment till discharge. RESULTS A total of 92 isolated traumatic head injury patients were included in the study. Number of females (19.5 %) were significantly less when compared to males. The Pearson correlation coefficient between FOUR score and GCS was calculated to be 0.945, 0.962 and 0.951 respectively at the time of presentation, after 6 hours and isolated traumatic head injury. After 24 hours in patients with isolated traumatic head injury, Cohen’s weighted Kappa of GCS and FOUR score inter reliability was 0.956 and 0.985 respectively. Area under receiver operating characteristic curve (ROC) for GCS and FOUR score with Modified Rankins Score was 0.951 and 0.951. Area under ROC for mortality for GCS and FOUR score was 0.974 and 0.997 respectively. CONCLUSIONS As per our results, there is an excellent correlation between GCS and FOUR score in head injury patients. The FOUR score aims to overcome these shortcomings with a scale that is both simple to use and comprehensive in its overall neurologic assessment of the isolated traumatic head injury patients. FOUR score might prove to be a better tool to evaluate the consciousness of head injury patients and help in detection and stratification of these patients and in monitoring the efficiency of ongoing treatment. KEYWORDS Four Score, GCS, Head Injury

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