LAUSR

The Glasgow Coma Scale and its derived Score have been adopted throughout the world for assessing the degree of impaired responsiveness in traumatic brain injury and other kinds of acute brain damage. In this historical vignette, we describe how the foundations for their enduring success were laid during their initial development. In order to provide a unique additional background and context, the material from interviews with one of the originators of the scale was brought together with information from key publications in the early years after the first description of the scale in 1974. This historical investigation shows how the contents of the eye, verbal and motor components of the scale were assembled through analysis of previous systems, guided by early clinimetric principles. Its reproducibility as a tool for clinical communication was confirmed through innovative studies of inter-observer variability. To test its validity international collaborations linking units in Britain, the Netherlands and the US were pursued. These were accompanied by the creation of the total Glasgow Coma Scale Score with a 6 point motor scale. The observation that outcomes after severe head injury was very similar in the different countries, despite marked variations in management, stimulated controversy that promoted further interest in traumatic brain injury research and a recommendation for the worldwide use of the scale as a common severity marker. Inclusion of the scale in major developments such as the ATLS and the Traumatic Coma Data cemented its influential position in clinical care and research for the succeeding decades.