1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury. 16 terms included coma, semicoma, stupor, confusion, obtundation. Tedious and not unified.1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury. 16 terms included coma, semicoma, stupor, confusion, obtundation. Tedious and not unified.1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury. 16 terms included coma, semicoma, stupor, confusion, obtundation. Tedious and not unified.1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury. 16 terms included coma, semicoma, stupor, confusion, obtundation. Tedious and not unified.1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury. 16 terms included coma, semicoma, stupor, confusion, obtundation. Tedious and not unified.
Glasgow Coma Scale Past, Present, Future KKH Morning Teaching - March 2013 Tan Hon Liang Past: Background 1940s WWII: Medical Research Council, UK issued glossary of terms used in cases of head injury 16 terms included coma, semi-coma, stupor, confusion, obtundation Tedious and not unified Past: Background Advent of Critical Care (1947 Polio outbreak) Improved survival with resuscitation Need for uniform language to communicate patient status and for research Intensivists wanted to know how to predict who was worth treating (or continuing to treat), and to assess the relative value of alternative management Past: Background In 1974 (Sir) Graham Teasdale (1940 - ) Knighted 2006 Bryan Jennett (1926-2008) RCS President 2003-2006 Other fame: “Economy Class Syndrome” Computerized database Neurosurgeons in Glasgow Lancet 1974 Jul 13;2 (7872):81-4 Assessment of coma and impaired consciousness A practical scale Citation count: 7417 Past: Background Original 14 point scale intended to objectively determine the severity of brain dysfunction and coma six hours after the occurrence of head trauma Why hours? Subsequent revised in 1976 with the addition of a sixth point in the motor response subscale for “withdrawal from painful stimulus” Past: Background Accepted classification: 13-15 (mild HI) 9-12 (moderate HI) < (severe HI) Past: Background World wide adoption contributed in no small part by nurses Easy to chart Past: Background Numerical, easy to analyze Since 1974, > 4000 articles published Added into other scores: APACHE, SAPS, TRISS, CRAMS, ASCOT Used to prognosticate Used to recommend treatment: WFNS for SAH, ATLS for intubation Advocates and detractors Past: Background How about kids? Clinical Case You are informed that this child was found by her parents drowsy at home in bed She is known to have epilepsy You assess the patient… Clinical Case Eyes not open to stimulus Speech is incoherent and slurred There is flexion of her upper limbs to stimulus Clinical Case What you next? Do you intubate this patient? Advocates On the basis of recommendations from the American College of Surgeons Committee on Trauma, the European Society of Intensive Care Medicine and the Eastern Association for the Surgery of Trauma, GCS 8 had impaired airway reflexes So GCS