The Glasgow Coma Scale and Evidence-Informed Practice: a critical review of where we are and where we need to be

Mary Braine, Neal F. Cook

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)
338 Downloads (Pure)


Aims and objectives. This paper aims to critically consider the evidence since theGlasgow Coma Scale was first launched, reflecting on how that evidence hasshaped practice. It illustrates the lack of clarity and consensus about the use ofthe tool in practice and draws upon existing evidence to determine the route toclarity for an evidence-informed approach to practice.Background. The Glasgow Coma Scale has permeated and influenced practice forover 40 years, being well-established worldwide as the key tool for assessing levelof consciousness. During this time, the tool has been scrutinised, evaluated, chal-lenged and re-launched in a plethora of publications. This has led to an insightinto the challenges, and to some extent the opportunities, in using the GlasgowComa Scale 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 amore comprehensive understanding of the Glasgow Coma Scale in practice and isbased on searches of Scopus, Web of Knowledge, PubMed, Science Direct andCINAHL databases.Results. While the Glasgow Coma Scale has been rivalled by other tools in anattempt 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 fur-ther research into its use and a clear education strategy to standardise implemen-tation in practice.Conclusion. Further exploration is needed into the application of painful stimuliin using the Glasgow Coma Scale to assess level of consciousness. In addition, arobust educational strategy is necessary to maximise consistency in its use inpractice.Relevance to clinical practice. The evidence illustrates inconsistency and confu-sion in the use of the Glasgow Coma Scale in practice; this has the potential tocompromise care and clarity around the issues is therefore necessary.
Original languageEnglish
Pages (from-to)280-293
JournalJournal of Clinical Nursing
Issue number1-2
Early online date22 Dec 2016
Publication statusPublished (in print/issue) - Jan 2017


  • eye opening response
  • Glasgow Coma Scale
  • motor response
  • neurological assessment
  • painful stimuli


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