Table 1.
Glasgow Outcome Scale (GOS) Measures
| Scoring categories | How data were acquired | Advantages | Limitations | References | |
|---|---|---|---|---|---|
| Unstructured GOS | D = 1; VS = 2; SD = 3; MD = 4; GR = 5 | Patient in-person visits (hospital or home) were preferred. If not possible, then phone interviews and/or interviewing of nurses, physicians, or others with knowledge of the patient's status.The same trained individual collected data for all GOS measures on a particular participant. The same ordering was obtained for all subjects: uGOS, then GOS, then GOS-E. | Interrater reliability is 95% agreement. Considered clinical trials “gold standard” for outcome in adults with TBI until GOS/GOS-E. | Lack of standard interview, modest interrater reliability; disproportionate weighting of physical disability relative to cognitive impairment and behavioral disturbance. | References41–45 |
| GOS | D = 1; VS = 2; SD = 3; MD = 4; GR = 5 | Interrater reliability is 92–95% agreement. Interrater weighted kappa = 0.85. Emphasis on change from pre-injury functioning and subject's capacity to perform adaptive activities, occupational, and social roles. | Some investigators have reported misclassification rates of 17–40% for GOS outcomes in clinical trials. Compared with GOS-E, not as sensitive to 3-month change. Considered as blunt outcome. | References11,12,43,46–50 | |
| GOS-E | D = 1; VS = 2; Lower SD = 3; Upper SD = 4; Lower MD = 5; Upper MD = 6; Lower GR = 7; Upper GR = 8 | Interrater reliability is 78% agreement. Interrater weighted kappa = 0.84. Interrater kappa = 0.85. More associated with measures of functional outcome, neuropsychological status, and affective functioning, compared with GOS. | Low ceiling that does not adequately represent the range of impairment within GR categories. Considered as blunt outcome. May fail to capture the multi-faceted effects of TBI and its sensitivity to subtle changes, especially in the cognitive dimension. | References11,12,43,47,48,50–53 |
D, Death; GR, Good Recovery; GOS, Glasgow Outcome Scale; GOS-E, Extended Glasgow Outcome Scale; MD, Moderately Disabled; SD, Severely Disabled; TBI, traumatic brain injury; uGOS, unstructured Glasgow Outcome Scale; VS, Vegetative State.