The Glasgow Coma Scale: Do We Know How to Assess?

Abstract

Objective: to determine the knowledge of GCS amongst clinical staff that cares for Traumatic brain injury (TBI) patients. Methods: A self-administered anonymous questionnaire was used to assess the knowledge of Junior Nurses (JNs), Senior Nurses (SNs), Junior Doctors (JDs) and Specialist Registrars (SRs) working with TBI patients. Following this, a PowerPoint based tutorial was delivered to staff within the department. 4 months later, same questionnaire was given out and results compared. Results The initial questionnaire had an overall correct response rate of 53.5% with only 9.7% of all healthcare professionals accurately scoring the GCS of a patient in a clinical scenario (JNs=0%, SNs=9.1%, JDs=20%, SRs=20%). Following the delivery of teaching, the repeat questionnaire had an overall correct response rate of 92.9% with 71% accurately scoring the GCS in the scenario (JNs=63.6%, SNs=70%, JDs=83.3%, SRs=75%). Results demonstrated a higher level of knowledge amongst doctors with overall correct response rates of 84% for JDs and SRs, compared to 36% and 41.8% for JNs and SNs respectively. The greatest improvement overall was seen in JNs who gave correct responses to 89.1% of questions in the follow up questionnaire compared to 36% in initial questionnaire. Conclusions Our study identified inconsistencies in knowledge of GCS and its application amongst staff in the department and demonstrated that the intervention of a single teaching session could improve this. Improving the accuracy of GCS calculation allows for better assessment, monitoring, prognostication and use of imaging facilities and is necessary to optimise outcome in TBI patients.