Confounding factors impacting the Glasgow coma score: a literature review

The Glasgow coma score (GCS) is a clinical tool used to measure level of consciousness in traumatic brain injury and other settings. Despite its widespread use, there are many inaccuracies in its reporting. One source of inaccuracy is confounding factors which affect consciousness as well as each sub-score of the GCS. The purpose of this article was to create a comprehensive list of confounding factors in order to improve the accuracy of the GCS and ultimately improve decision-making.

An English language literature search was conducted discussing GCS and multiple other keywords. Ultimately, 64 out of 3972 articles were included for further analysis.

A multitude of confounding factors were identified which may affect consciousness or GCS sub-scores including the eye exam, motor exam and the verbal response.

An up-to-date comprehensive list of confounding factors has been created that may be used to aide in GCS recording in hopes of improving its accuracy and utility.