Prehospital use of the Glasgow Coma Scale in severe head injury

To determine the prognostic value of prehospital Glasgow Coma Scale (GCS) scores in severe blunt head injuries, the GCS at the scene of injury (INGCS) and the GCS in the emergency department (EDGCS) were compared with neurologic outcomes in 33 consecutive head-injured patients. Patients were categorized according to final outcome: Group I (n = 7) had no neurologic deficits, group II (n = 3) had only minor neurologic deficits, group III (n = 11) had major neurologic deficits, and group IV (n = 12) died. Mean INGCS was not significantly different for any of the four groups (range 4.14 to 4.67). However, mean EDGCS was significantly higher (P less than .05) for group I (9.43 +/- 4.08) than for group IV (5.17 +/- 3.13), and mean EDGCS for groups I and II (8.8 +/- 3.99) were significantly higher (P less than .05) than that of groups III and IV (5.7 +/- 2.88). The net change in GCS (EDGCS--INGCS) was significantly higher (P less than .05) for groups I and II (4.5 +/- 4.4) than for groups III and IV (1.3 +/- 2.91). We conclude that INGCS alone has no prognostic value, but that EDGCS and any prehospital change in GCS may have prognostic value for severely head-injured patients.