Different versions of Glasgow coma scale in British hospitals

Editor—We disagree with Wiese that the universal use of the revised 15 point Glasgow coma scale is the panacea to solve the recurrent problems communicating with local neurosurgical units.^1-3

We believe that much of the difficulty and confusion is due to assigning a number score to an individual's motor, verbal, and eye responses and subsequently totalling up the three components. At best, this requires decoding by the receiving clinician, and, at worst, valuable information can be lost because of the impossibility of conversion back to clinical responses unless the component scores and denominator are known. To avoid these problems the actual clinical response, rather than a numerical code, should be communicated and documented in the notes.

The original Glasgow coma scale by Teasdale and Jennett does not describe a numerical system.² The subsequent introduction of such a tool has facilitated stratification of groups of patients in research settings.

As a point of interest the neuro-observation charts in use in our unit and, perhaps more importantly, at the Institute of Neurological Sciences in Glasgow continue to describe the original 14 point scale, casting some doubt on Wiese's quote that the revised scale has been the accepted version for 25 years. The important message is providing information in a simple and easily understandable form, whichever version of the Glasgow coma scale is preferred.