The Glasgow coma scale and evidence-informed practice : a critical review of where we are and where we need to be

Braine, ME; Cook, NF

Abstract

Aims and Objectives
This critical review considers the evidence since the Glasgow Coma Scale (GCS) was first launched, reflecting on how that evidence has shaped practice. It illustrates the lack of clarity and consensus about the use of the tool in practice and draws upon existing evidence in order to determine the route to clarity for an evidence-informed approach to practice.

Background
The GCS has permeated and influenced practice for over 40 years, being well-established worldwide as the key tool for assessing level of consciousness. During this time, the tool has been scrutinised, evaluated, challenged and relaunched in a plethora of publications. This has led to an insight into the challenges, and to some extent the opportunities, in using the GCS in practice but has also resulted in a lack of clarity.

Design
This is a discursive paper that invites readers to explore and arrive at a more comprehensive understanding of the GCS in practice and is based on searches of Scopus, Web of Knowledge, PubMed, Science Direct and CINAHL databases.

Results
While the GCS has been rivalled by other tools in an attempt to improve upon it, a shift in practice to those tools has not occurred. The tool has withstood the test of time in this respect, indicating the need for further research into its use and a clear education strategy to standardise implementation in practice.

Conclusion
Further exploration is needed into the application of painful stimuli in using the GCS to assess level of consciousness. Additionally, a robust educational strategy is necessary to maximise consistency in its use in practice.

Citation

Braine, M., & Cook, N. (2016). The Glasgow coma scale and evidence-informed practice : a critical review of where we are and where we need to be. Journal of Clinical Nursing, 26(1-2), 280-293. https://doi.org/10.1111/jocn.13390

• Journal Article Type: Article
• Acceptance Date: May 14, 2016
• Online Publication Date: May 24, 2016
• Publication Date: May 24, 2016
• Deposit Date: May 31, 2016
• Publicly Available Date: May 26, 2017
• Journal: Journal Of Clinical Nursing
• Print ISSN: 0962-1067
• Electronic ISSN: 1365-2702
• Publisher: Wiley
• Volume: 26
• Issue: 1-2
• Pages: 280-293
• DOI: https://doi.org/10.1111/jocn.13390
• Publisher URL: http://dx.doi.org/10.1111/jocn.13390
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2702