Pettigrew L E, Wilson J T, Teasdale G M
Department of Neurosurgery, University of Glasgow, United Kingdom.
J Neurosurg. 1998 Dec;89(6):939-43. doi: 10.3171/jns.1998.89.6.0939.
The Glasgow Outcome Scale (GOS) is widely used to assess outcome after head injury, but is recognized as having a number of shortcomings that are highlighted and investigated in this study. The authors pursued two goals: 1) investigating the practicality of using a standard set of questions as part of a structured interview to assign GOS scores, and 2) studying the role of preinjury problems in confounding postinjury assessment of disability.
Several of the major limitations of the GOS appear to arise from the use of a format that encourages impressionistic ratings. In the present study the authors examined the use of a standard interview for assessing the GOS covering five areas of social disability. Ratings were made for 80 head-injured patients. The results show that the rating based on the GOS provides an assessment of disability that is more complete than that given by an alternative scale of functional disability (Disability Rating Scale [DRS]) and much more complete than an assessment of physical disability (Barthel Activities of Daily Living [ADL] index). A measure of preinjury dependency was made revealing that, within this sample, 20% of patients required supervision in basic ADL before their injury.
Assignment of GOS scores based on information obtained using a structured interview format provides a more comprehensive assessment of disability than using the DRS or the ADL index. There is a need to standardize attitudes about preinjury dependency in assessing disability after head injury.
格拉斯哥预后量表（GOS）被广泛用于评估头部损伤后的预后，但该量表存在一些缺点，本研究对这些缺点进行了重点分析和研究。作者有两个目标：1）研究将一组标准问题作为结构化访谈的一部分来确定GOS评分的实用性；2）研究伤前问题在混淆伤后残疾评估中的作用。
GOS的几个主要局限性似乎源于其采用的一种鼓励主观评分的形式。在本研究中，作者研究了使用标准访谈来评估涵盖社会残疾五个领域的GOS。对80例头部受伤患者进行了评分。结果显示，基于GOS的评分对残疾的评估比另一种功能残疾量表（残疾评定量表[DRS]）更全面，比身体残疾评估（巴氏日常生活活动[ADL]指数）更全面得多。对伤前依赖程度的一项测量表明，在这个样本中，20%的患者在受伤前的基本日常生活活动中需要有人监督。
基于结构化访谈获得的信息来确定GOS评分，比使用DRS或ADL指数能更全面地评估残疾情况。在评估头部损伤后的残疾时，有必要规范对伤前依赖程度的态度。
