Glasgow Coma Scale in Brazilian Portuguese: foundation translation and cultural adaptation study

To establish the foundation for the translation and culturally adaptation of the Glasgow Coma Scale into Brazilian Portuguese as part of a larger project translating and validating another tool, the SCAT-5, of which the Glasgow Coma Scale is a component. The Glasgow Coma Scale assesses the level of consciousness and neurological prognosis after traumatic brain injury. However, a systematic translation and cultural adaptation into Portuguese has never been performed.

Three Brazilian individuals independently translated the original Glasgow Coma Scale from English to Portuguese. The Glasgow Coma Scale is divided into three separate modules: eye opening (scored between 1 and 4), verbal response (scored between 1 and 5), and best motor response (scored between 1 and 6). The total score is calculated by adding up the scores for each individual module, so it ranges between 3 and 15. Each sentence or expression within the original Glasgow Coma Scale questionnaire was evaluated individually. A multi-professional committee voted and discussed the best translation for each sentence or expression and combined them into a single version, which was back-translated into English by two separate native English professionals and compared with the original to resolve semantic discrepancies. The resulting combined and optimized version was tested twice in a fortnight and applied to 36 athletes who had suffered brain trauma, with cerebral concussion, and were treated in a sports-specialized ambulatory. This test was conducted to evaluate mainly the comprehension of the physician applying the translated questionnaire.

Patients were aged between 18 and 45 years, mostly rugby players (23/36), and female (23/36). There was no variability in the results between patients or between the same patient in both evaluations; all patients were consistently evaluated as having a Glasgow score of 15, since all patients were outpatients.

This study laid the foundations for the translation and cultural adaptation of the Glasgow Coma Scale for Brazilian physicians. This translation may contribute to facilitating its use and standardizing the healthcare of patients with traumatic brain injury in Brazil. Further studies may be necessary to evaluate the use of the translated version in patients with lower levels of consciousness (i.e., lower Glasgow Coma Scale scores).