This post is my latest update on for my research challenge.

The Article: Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale

Green, S. M. (2011). Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of emergency medicine, 58(5), 427-430. Elsevier Inc. doi:10.1016/j.annemergmed.2011.06.009

Big Idea:

The Glasgow Coma Scale was not originally intended to be a ubiquitous neurological scoring system. There is evidence to demonstrate the GSC is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound. Therefore we should consider using Simplified Motor Scales (SMS) that provide the same information, are easier to remember, are statistically derived and externally valid (p. 428)

Evidence:

This article is an editorial, so it is not primary research. The article references a number of other primary sources of evidence including recently published peer-reviewed literature from well respected journals. Referenced studies indicate the GSC has poor inter-rater reliability, it is not consistently remembered, there are different versions (usually outdated 12-point evaluations), it is inconsistent which prevents prognostic value (p. 428 par 1)

Quotable:

"It is time to abandon the Glasgow Coma Scale (GCS). As discussed below, this ubiquitous neurologic scoring system is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound." p. 427

"Some traditionalists will no doubt object to the blasphemy of "dumbing down" the GCS, but why tolerate pointless complexity?" p. 428

"The GCS is intellectually appealing to health care providers in that it creates apparent order out of disorder. It ambitiously tackles the enormous complexity of human neurologic response and organizes (oversimplifies) it into a tangible, appealing yardstick that cannot fail to impress with its seeming accuracy and precision. We want to believe that medicine can be this objective, and thus we tolerate the delusion." p. 429

So What?

This article was fascinating to me for two reasons. First, as a student I remember trying very hard to memorize the GCS and found it difficult, but thought I was the problem. Second, working in a simulation lab now I find it interesting to see how students do tend to want black and white answers. It is fascinating to step back and see the dialogue that happens in the literature as evidence evolves and researchers have to push for change, not an easy thing to do. As an educator I wonder how we make this apparent to students, since we have to mark them on something and they want very defined and specific answers, yet their knowledge will hopefully and should always be changing (read: evolving) with new evidence.