The GSC assesses a person's level of consciousness after injury. The scale can be used as part of an initial assessment or to monitor changes in consciousness over time.
15
10-15 minutes
Adolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by the Rehabilitation Measures Team; Updated with references for the TBI population by Erin Donnelly and the TBI EDGE task force of the Neurology Section of the APTA in 2012.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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TBI EDGE |
LS |
NR |
NR |
NR |
NR |
Recommendations for use based on ambulatory status after brain injury:
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Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
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TBI EDGE |
N/A |
N/A |
N/A |
N/A |
Recommendations for entry-level physical therapy education and use in research:
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Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
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TBI EDGE |
Yes |
Yes |
Yes |
Not reported |
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Head Injury: (Balestreri et al, 2004; n = 358; mean age = 34 (16) years; Median GCS at admission = 6 (range from 3 to 13) points)
GCS score of 3 on presentation resulted in:
Head Injury: (Balestreri et al, 2004)
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Glasgow Coma Scale Norms: |
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Year |
n |
GCS median (range) |
GOS median (range) at six months |
Age mean (SD) |
|
1992 |
29 |
4 (3–11) |
3 (1–5) |
30 (17) |
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1993 |
39 |
6 (3–15) |
4 (1–5) |
32(15) |
|
1994 |
40 |
5 (3–15) |
4 (1–5) |
30 (13) |
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1995 |
33 |
6 (3–12) |
4 (1–5) |
34 (16) |
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1996 |
43 |
5 (3–14) |
3 (1–5) |
33 (17) |
|
1997 |
31 |
6 (3–14) |
4 (1–5) |
37 (17) |
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1998 |
52 |
7 (3–14) |
4 (1–5) |
36 (16) |
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1999 |
30 |
7 (3–14) |
4 (1–5) |
30 (15) |
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2000 |
27 |
7 (3–13) |
3 (1–5) |
38 (18) |
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2001 |
36 |
6 (3–12) |
4 (1–5) |
39 (16) |
Brain Injury: (Balestreri et al, 2004; n = 358; mean age = 34 (16) years; Median GCS at admission = 6 (range from 3 to 15) points.
"The GCS's predictive validity, at least in predicting Glasgow Outcome Scores, is questionable. In some years the GCS demonstrated adequate correlations with the GOS (assessed 6 months later). In other years these correlations were poor."
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GCS and GOS Predictive Validity: |
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Year |
Strength |
correlation; GOS 6 months after first GCS assessment |
p |
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1992 |
Adequate |
0.55 |
0.019* |
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1993 |
Adequate |
0.39 |
0.015* |
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1994 |
Adequate |
0.43 |
0.006* |
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1995 |
Adequate |
0.42 |
0.016* |
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1996 |
Adequate |
0.39 |
0.011* |
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1997 |
Poor |
0.01 |
0.978 |
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1998 |
Poor |
0.21 |
0.131 |
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1999 |
Poor |
-0.16 |
0.932 |
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2000 |
Poor |
0.00 |
1.000 |
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2001 |
Poor |
0.29 |
0.087 |
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*significant correlation |
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GCS = Glasgow Coma Scale |
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Head Injury: presenting with a GCS of 3 six-months after injury: (Chamoun et al, 2009; n = 189; survivor mean age = 33.3 (12.8), patients who died 40.3 (16.97) years)
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Glasgow Outcome Score |
n (%) |
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1 |
18 (9.8%) |
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2 |
7 (3.7%) |
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3 |
35 (18.5%) |
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4 |
22 (11.6%) |
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Mortality |
93 (49.2%) |
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Lost to follow-up |
14 (7.4%) |
Head Injury: (Balestreri et al, 2004)
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Glasgow Coma Scale Norms: |
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|
|
|
Year |
n |
GCS median (range) |
GOS median (range) at six months |
Age mean (SD) |
|
1992 |
29 |
4 (3–11) |
3 (1–5) |
30 (17) |
|
1993 |
39 |
6 (3–15) |
4 (1–5) |
32(15) |
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1994 |
40 |
5 (3–15) |
4 (1–5) |
30 (13) |
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1995 |
33 |
6 (3–12) |
4 (1–5) |
34 (16) |
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1996 |
43 |
5 (3–14) |
3 (1–5) |
33 (17) |
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1997 |
31 |
6 (3–14) |
4 (1–5) |
37 (17) |
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1998 |
52 |
7 (3–14) |
4 (1–5) |
36 (16) |
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1999 |
30 |
7 (3–14) |
4 (1–5) |
30 (15) |
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2000 |
27 |
7 (3–13) |
3 (1–5) |
38 (18) |
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2001 |
36 |
6 (3–12) |
4 (1–5) |
39 (16) |
Chronic Subdural Hematoma: (Amirjamshidi et al, 2006; n = 128; mean age = 57.2 (range = 9 to 88) years; Iranian sample)
Head Injury (s/p blunt force trauma) (Shanmuganathan, et al., 2004; n= 21 patients with TBI secondary to blunt trauma mean age 37.8 (41.3) years; n=11 healthy control subjects, mean age 32.7 (19.2) years)
ICU Patients: (Fischer et al, 2010; n = 267; mean age = 63 (17) years; both assessments within 1 hour of each other)
ICU Patients (multiple diagnoses including neurological): (Fischer et al, 2010; n = 267; mean age = 63 (17) years; both assessments within 1 hour of each other)
ICU (diagnosed with neurological diseases): (Ting et al., 2010; n= 154; mean age = 56.7 years; Total mortality ratio= 29.87%)
Standard Cut Scores:
Emergency Department Patients: (Gill et al, 2004; n = 116; median age = 54 (18–90) years; diagnosis, trauma = 28% Infection = 16%)
Emergency Department Patients: (Gill et al, 2004; n = 116; median age = 54 (18–90) years; diagnosis, trauma = 28% Infection = 16%; ratings by 2 residency trained attending emergency physicians, scores within 5 minutes)
55-74% of paired measurements were identical, and 6-17% were 2 or more points apart. Agreement was only moderate with this diverse ED population.
Pediatric TBI: (Chung et al, 2006; n = 309; mean age = 6.19 (2.27) years; outcomes assessed at 4.11 (2.07) years on average; Taiwanese sample)
Amirjamshidi, A., Abouzari, M., et al. (2007). "Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma." J Clin Neurosci 14(12): 1240-1241. Find it on PubMed
Balestreri, M., Czosnyka, M., et al. (2004). "Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years." J Neurol Neurosurg Psychiatry 75(1): 161-162. Find it on PubMed
Chamoun, R. B., Robertson, C. S., et al. (2009). "Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation." J Neurosurg 111(4): 683-687. Find it on PubMed
Chung, C. Y., Chen, C. L., et al. (2006). "Critical score of Glasgow Coma Scale for pediatric traumatic brain injury." Pediatr Neurol 34(5): 379-387. Find it on PubMed
Fearnside, M. R., Cook, R. J., et al. (1993). "The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables." Br J Neurosurg 7(3): 267-279. Find it on PubMed
Fischer, M., Ruegg, S., et al. (2010). "Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study." Crit Care 14(2): R64. Find it on PubMed
Gill, M. R., Reiley, D. G., et al. (2004). "Interrater reliability of Glasgow Coma Scale scores in the emergency department." Ann Emerg Med 43(2): 215-223. Find it on PubMed
Phuenpathom, N., Choomuang, M., et al. (1993). "Outcome and outcome prediction in acute subdural hematoma." Surg Neurol 40(1): 22-25. Find it on PubMed
Shanmuganathan, K., Gullapalli, R. P., et al. (2004). "Whole-brain apparent diffusion coefficient in traumatic brain injury: correlation with Glasgow Coma Scale score." American journal of neuroradiology 25(4): 539-544.
Ting, H. W., Chen, M. S., et al. (2010). "Good mortality prediction by Glasgow Coma Scale for neurosurgical patients." Journal of the Chinese Medical Association 73(3): 139-143.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.