The Story of the Development and Adoption of the Glasgow Coma Scale: Part I, The Early Years

The Glasgow Coma Scale and its derived Score have been adopted worldwide for assessing the degree of impaired responsiveness in traumatic brain injury and other kinds of acute brain damage. In this historical vignette, we describe how the foundations for their enduring success were laid during their initial development. To provide a unique additio nal background and context, the material from interviews with one of the originators of the scale was brought together with information from key publications in the early years after the first description of the scale in 1974. This historical investigation shows how the contents of the eye, verbal, and motor components of the scale were assembled through analysis of previous systems, guided by early clinimetric principles. Its reproducibility as a tool for clinical communication was confirmed through innovative studies of interobserver variability. To test its validity, international collaborations linking units in Britain, the Netherlands, and the United States were pursued. These collaborations were accompanied by the creation of the total Glasgow Coma Score with a 6-point motor subdivision. The observation that outcomes after severe head injury were similar in the different countries, despite marked variations in management, stimulated controversy that promoted further interest in traumatic brain injury research and a recommendation for the worldwide use of the scale as a common severity marker. Inclusion of the scale in major developments such as the Advanced Trauma Life Support (ATLS) and the National Traumatic Coma Databank cemented its influential position in clinical care and research for the succeeding decades.