The Glasgow Coma Scale 40 years on: a review of its practical use

This year sees the celebration of the 40th anniversary of the Glasgow Coma Scale (GCS), which is as relevant in clinical decision making now as it was 40 years ago. The GCS was originally devised in 1974 as a simple bedside tool to improve clarity and consistency in communication about patients with impaired consciousness in a wide range of disorders. Impaired consciousness is an expression of dysfunction of the brain as a whole. Over the decades there has been increasing evidence of variation in the consistency of GCS assessment in clinical practice. Education and experience in the use of the GCS are important factors that have been shown to improve the reliability and accuracy of GCS scoring. The use of different examination techniques, especially the application of painful stimulation, contributes to inconsistency. A standardised approach is required for safe therapeutic clinical decision making and clear communication between health professionals. Novel approaches to education are required to standardise practice, and explicit guidelines aimed at improving its overall application in clinical practice are needed.