Different versions of Glasgow coma scale in British hospitals

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7431.110-a (Published 09 January 2004) Cite this as: BMJ 2004;328:110

Author's reply

  1. Martin Wiese, locum lecturer (wiese{at}doctors.org.uk)
  1. Emergency Department, St Mary's Hospital, London W2 1NY

    EDITOR—These authors highlight communication issues concerning the Glasgow coma scale and point out the greater ease of use of its original version. Teasdale and Jennett themselves were well aware of the difficulties that distinguishing between normal and abnormal flexion may pose to non-specialists.1

    The inventors of the scale never gave any explanation for introducing the additional point in 1976 and continue to use the original scale in their own unit in Glasgow.2 In spite of this, and although no research has examined which scale is the better one, the original version has curiously disappeared from medical literature and teaching. Most healthcare professionals working today are therefore only familiar with the 15 point scale. Accordingly, staff interviewed during the survey were often surprised when the observation charts in their unit were showing the original version. Most had never noticed this before.

    In many cases, hospitals may have not updated their stationery consistently. As a result, staff in the United Kingdom need to be mindful of the parallel existence, sometimes in the same hospital, of the two scales. But can it really be justified that doctors and nurses should have to worry about which one to use every time they change jobs? Teasdale's and Jennett's views on this matter would surely be of interest.

    I did not explore how the level of consciousness is assessed in the units not using the Glasgow coma scale.


    • Competing interests None declared.