"Simplicity does not precede complexity, but follows it": evolution of the Glasgow Coma Scale

Physicians' Knowledge of the Glasgow Coma Scale in a Nigerian University Hospital: Is the Simple GCS Still Too Complex?

OBJECTIVE

The Glasgow Coma Scale, GCS, is a universal clinical means of quantifying the level of impaired consciousness. Although physicians usually receive undergraduate and postgraduate training in the use of this scale in our university hospital we are aware of studies suggesting that the working knowledge of the GCS among practising physicians might not be adequate.

METHODS

We carried out a questionnaire-based survey across all specialties and levels of training of physicians in active patient care in a Nigerian university hospital.

RESULTS

Of the 100 physicians sampled, 98 correctly spelled out what the three-letter abbreviation, GCS, stands for. Ninety-three percent also conceded it to be an important clinical rating scale. However, only 55-89% of the participants correctly identified the three respective clinical variables, (eye opening, verbal response, and motor response), of the GCS. More particularly, the participants' ability to itemize and correctly score all the respective components of each of the three clinical variables ranged from 0 to 35% across specialties and levels of training. Performance was best for the four-item eye opening variable and, worst for the six-item motor response variable.

CONCLUSION

In our university hospital, practising physicians' working knowledge of the GCS is inadequate and is dependent on the degree of the complexity of each of the three clinical variables of the scale.