Glasgow Outcome Scale GOS and GOS-E

This Glasgow outcome scale GOS and GOS-E assesses status in patients with traumatic brain injury by the original scale and by the Glasgow outcome extended scale. Discover more about the two scales and their utility in TBI below the form.

Glasgow Outcome Scale

■ 1 Dead

■ 2 Persistent Vegetative State

Patient exhibits no obvious cortical function.

■ 3 Severe Disability (Conscious but disabled)

Patient depends upon others for daily support due to mental or physical disability or both.

■ 4 Moderated Disability (Disabled but independent)

Patient is independent as far as daily life is concerned. The disabilities found include varying degrees of dysphasia, hemiparesis, or ataxia, as well as intellectual and memory deficits and personality changes.

■ 5 Recovery

Resumption of normal activities even though there may be minor neurological or psychological deficits.

Glasgow Outcome Scale – Extended Version

■ 1 Dead

■ 2 Vegetative State

Condition of unawareness with only reflex responses but with periods of spontaneous eye opening.

■ 3 Low Severe Disability

■ 4 Upper Severe Disability

Patient who is dependent for daily support for mental or physical disability, usually a combination of both. If the patient can be left alone for more than 8h at home it is upper level of SD, if not then it is low level of SD.

■ 5 Low Moderate Disability

■ 6 Upper Moderate Disability

Patients have some disability such as aphasia, hemiparesis or epilepsy and/or deficits of memory or personality but are able to look after themselves. They are independent at home but dependent outside. If they are able to return to work even with special arrangement it is upper level of MD, if not then it is low level of MD.

■ 7 Low Good Recovery

■ 8 Upper Good Recovery

Resumption of normal life with the capacity to work even if pre-injury status has not been achieved. Some patients have minor neurological or psychological deficits. If these deficits are not disabling then it is upper level of GR, if disabling then it is lower level of GR.

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How does the Glasgow outcome scale GOS and GOS-E work?

This is a form that presents the two outcome scales, the original version and the extended one that were compiled together in order to provide a stratification tool to clinicians trying to assess a TBI traumatic brain injury by the Glasgow method.

The first scale, the original version of GOS evaluates cerebral traumas after the model of Jennett and Bond, first described in 1975.

It contains five statuses and allows the medical professional a rating for an objective assessment of recovery. It can also be used for long term prediction of rehabilitation after TBI.

The Extended Glasgow Outcome Scale GOS-E addresses the limitations of the first version and comes with an 8 item rating system and a structured interview available to use with. By comparison, the second version has shown more reliability in practice and content validity and is also more sensitive to change in mild and moderate traumatic brain injuries.

Both of these scales are very popular and used in practice at some point in the quantification of recovery level of TBI patients as they provide a general assessment of mental function, trauma severity and outcome after head injury. In research of traumatic injury GOS are recommended at 3, 6 and 12 months.

Based on this study, there are other rehabilitation models such as the Disability Rating Scale that take the model further and include the interview items as well as a scale of status.

Traumatic Brain Injury (TBI)

This is an intracranial injury type that is caused by trauma to the head and includes a series of causes which are produced by an external force trauma from accidents, assaults or falls. Effects and severity range from minor concussion to severe brain injury and depend on the type and location of the injury.

It is a complex injury, classified by severity, mechanism (close or penetrating) and has a broad spectrum of symptoms and possible resultant disabilities.

TBI symptoms can vary in intensity depending on the brain damage. The following table explains the correlation with the Glasgow coma scale scores and the main characteristics:

Injury type	Glasgow Coma Scale	Post Traumatic Amnesia Loss of consciousness	Symptoms
Mild	13 - 15	< 1 day amnesia (0 – 30 minutes LOC)	- headaches
			- confusion
			- dizziness, blurred vision
			- fatigue, lethargy
			- behavioral changes, mood changes
Moderate	9 - 12	< 7 day amnesia (> 30 minutes - 24h LOC)	- same symptoms as mild state but worsened condition
			- seizures, restlessness
			- slurred speech
Severe	3 - 8	> 7 day amnesia (> 24h LOC)	- same symptoms as mild and moderate but much more severe
			- inability to awaken from sleep
			- numbness in extremities
			- convulsions, loss of coordination
			- cognitive or mental degradation
			- coma

References

1) Jennett B, Bond M. (1975) Assessment of outcome after severe brain damage. Lancet; 1(7905):480-4.

2) Wilson JTL, Pettigrew LEL, Teasdale GM. (1998) Structured interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for their use. Journal of Neurotrauma; 15:573-585.

08 Aug, 2015

Glasgow Outcome Scale GOS and GOS-E