National Trauma Research Institute, Melbourne, Victoria, Australia.
Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.
Emerg Med Australas. 2022 Jun;34(3):459-461. doi: 10.1111/1742-6723.13937. Epub 2022 Feb 27.
The wide-spread use of an initial 'Glasgow Coma Scale (GCS) 8 or less' to define and dichotomise 'severe' from 'mild' or 'moderate' traumatic brain injury (TBI) is an out-dated research heuristic that has become an epidemiological convenience transfixing clinical care. Triaging based on GCS can delay the care of patients who have rapidly evolving injuries. Sole reliance on the initial GCS can therefore provide a false sense of security to caregivers and fail to provide timely care for patients presenting with GCS greater than 8. Nearly 50 years after the development of the GCS - and the resultant misplaced clinical and statistical definitions - TBI remains a heterogeneous entity, in which 'best practice' and 'prognoses' are poorly stratified by GCS alone. There is an urgent need for a paradigm shift towards more effective initial assessment of TBI.
广泛使用初始“格拉斯哥昏迷量表（GCS）8 或更低”来定义和将“严重”与“轻度”或“中度”创伤性脑损伤（TBI）区分开来，这是一种过时的研究启发式方法，已成为一种流行病学上的便利，影响了临床护理。根据 GCS 进行分诊可能会延迟对迅速发展的损伤患者的治疗。因此，仅仅依靠初始 GCS 可能会给护理人员一种虚假的安全感，并且无法为 GCS 大于 8 的患者提供及时的护理。在 GCS 开发近 50 年后——以及由此产生的错误的临床和统计定义——TBI 仍然是一种异质实体，仅通过 GCS 就很难对“最佳实践”和“预后”进行分层。迫切需要向更有效的 TBI 初始评估方法转变。
