Different versions of Glasgow coma scale in British hospitals

Editor—Wiese surveyed the use of different versions of the Glasgow coma scale in British hospitals.¹ When passing on information about any scale the parameters of the scale must be declared. The Glasgow coma scale should include a numerator and denominator to avoid confusion: saying 14/14 or 14/15, for example, would show which version of the scale is being used.

It can be quite difficult for people unless they see it regularly to separate abnormal flexion—which is flexion, adduction, and internal rotation of the shoulder—from flexion and withdrawal—which is flexion, abduction, and external rotation of the shoulder. In the 14 point scale this differentiation is unnecessary.

Even the terms differentiating M4 and M5 of the 15 point scale are variable. If the reproducibility of the observations cannot be guaranteed between observers perhaps the simplified scale is better.

With correct training the 15 point scale is superior because it is the international standard for research and audit. For patient care, however, reproducibility across the multidisciplinary team is important. A changing coma scale is also important. Knowing how the score is generated is much more informative than simply being presented with a number over the telephone. It allows the receiving doctor to compile a clear picture of the clinical state of the patient. If a flexion motor response is described it can be clarified.

I wonder how conscious level is being assessed in the four observation units listed as not using the Glasgow coma scale.