Paul Brennan, co-creator of the Glasgow Coma Scale (GCS), has teamed up with the University of Edinburgh to develop a new assessment tool that builds on the initial GCS score.
The new Glasgow Coma Scale-Pupils score (GCS-P), presented in the Journal of Neurosurgery, includes a pupil reactivity score, which represents the number of nonreactive pupils (0, 1, or 2). This number is subtracted from the GCS score of 3-15, resulting in the GCS-P score of 1-15.
Using data on patient outcomes from the CRASH (Corticosteroid Randomisation After Significant Head Injury) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI) database, GCS-P showed similar performance to more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores.
The additional 2 lowest points offered by the GCS-Pupils scale extended the information about injury severity from a mortality rate of 51% and an unfavourable outcome rate of 70% at GCS score 3, to a mortality rate of 74% and an unfavourable outcome rate of 90% at GCS-P 1.
The authors stress that the combined GCS-P is not intended to replace the role of separate assessment and reporting of each component of the Glasgow Coma Scale and pupil response in the care of individual patients. This remains the most informative way of determining and sharing a picture of the patient’s condition and how it may be changing, they say.
