'Simplicity does not precede complexity, but follows it': Evolution of the Glasgow Coma Scale

摘要

Teasdale and Jennett (1) apparently devised their "practical scale for the assessment of impaired consciousness and coma" in a Glaswegian pub in 1974. Despite these humble origins and without attempts to validate or calibrate the motor, voice, or eye response scales, their proposal was adopted very rapidly. The original publication has >5000 citations. When consciousness has been assessed anywhere on the planet in the last &30 years, this legendary trip to the pub has been the starting point.That the scale was initially such a success is perhaps no surprise, given that at the time "when faced with an unconscious patient... many clinicians retreat from any formal scheme in favor of a general description of the patient's state, without clear guidelines as to what to describe and how to describe it" (1). The preexisting terms for impaired consciousness, including coma, lethargy, and stupor, now seem to be complex, vague, and frankly unhelpful