The Glasgow-Liège Scale. Prognostic value and evolution of motor response and brain stem reflexes after severe head...

In 1982, we developed a new coma scale, the Glasgow-Liège Scale (GLS), which combines the Glasgow coma scale (GCS) with the quantified analysis of five brain stem reflexes. After severe head injury, the two most important parameters for determining the degree of encephalic disturbances are motor responses (M) and brain stem reflexes (R). The object of this study was to further evaluate the prognosis ability of M and R on admission and during the first month after injury. The study is based on 141 patients. The highest score, during the first day, was less than or equal to 7 on the GCS and 12 on the GLS. Using a multiple group logistic discriminant analysis, we confirmed that, in the first 24 hours, the study of brain stem reflexes appears to be the one factor with the best prognostic ability. We also showed that the prognostic value of certain signs is optimal for a limited period. If, within the two variables M and R, recovery follows an identical pattern whatever the final outcome may be, the restructing speed differs for each outcome. M follows an exponential curve spread over a long period explaining its importance in the course of time. On the other hand, R follows a linear model with straight lines more or less parallel for each outcome. R evolves over a short period of time. These clinical findings give us the opportunity to discuss the physio-pathology of head injury.