{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Bodien YG"],"funding":["NINDS NIH HHS"],"pagination":["3295-3305"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC8917895"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["38(23)"],"pubmed_abstract":["In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured using the Glasgow Coma Scale (GCS) total score. The GCS total score however, may not accurately reflect level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS total scores and level of consciousness in a consecutive sample of 2455 adult subjects assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We assigned each GCS subscale score combination a level of consciousness rating based on published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3-8 = 13%; 9-12 = 5%; 13-15 = 82%. All GCS total scores between 4-14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7-11. Further, a wide range of total scores was associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3-6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity."],"journal":["Journal of neurotrauma"],"pubmed_title":["Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score."],"pmcid":["PMC8917895"],"funding_grant_id":["RF1 NS115268","U01 NS086090","UH3 NS095554","R21 NS109627"],"pubmed_authors":["Manley GT","Barber J","McCrea M","Foreman B","Zafonte R","Okonkwo D","Schnyer D","Duhaime AC","Bodien YG","Sugar G","Markowitz AJ","Giacino JT","Barra A","Badjatia N","Gaudette PhD E","Gopinath S","Yue JK","Puccio A","Vassar M","Taylor SR","Edlow BL","Robertson C","Merchant R","Ngwenya LB","Temkin NR","TRACK-TBI Investigators","Ferguson AR","Mukherjee P","Keene CD"],"additional_accession":[]},"is_claimable":false,"name":"Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score.","description":"In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured using the Glasgow Coma Scale (GCS) total score. The GCS total score however, may not accurately reflect level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS total scores and level of consciousness in a consecutive sample of 2455 adult subjects assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We assigned each GCS subscale score combination a level of consciousness rating based on published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3-8 = 13%; 9-12 = 5%; 13-15 = 82%. All GCS total scores between 4-14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7-11. Further, a wide range of total scores was associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3-6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity.","dates":{"release":"2021-01-01T00:00:00Z","publication":"2021 Dec","modification":"2025-04-05T10:17:22.194Z","creation":"2025-04-05T10:17:22.194Z"},"accession":"S-EPMC8917895","cross_references":{"pubmed":["34605668"],"doi":["10.1089/neu.2021.0199"]}}