ANALYZING OUTCOME OF TREATMENT OF SEVERE HEAD-INJURY - A REVIEW AND UPDATE ON ADVANCING THE USE OF THE GLASGOW OUTCOME SCALE

The Glasgow Outcome Scale (GOS), two decades after its description, re mains the most widely used method of analyzing outcome in series of se verely head-injured patients. This review considers limitations recogn ized in the use of the GOS and discusses a new approach to assessment, using a structured questionnaire-based interview, Assignments can be made to an extended eight-point scale (GOSE) as well as the original f ive-point approach-in each case, with a high degree of interobserver c onsistency. The assignments are coherent with the principles of the Wo rld Health Organization classification of impairments, disabilities, a nd handicaps, and their validity is supported by strong associations w ith the results of neuropsychological testing and assessment of genera l health status. The need to allow for disability existing before inju ry, issues concerning the time of assessment after injury, and subdivi sions of the scale into ''favorable'' and ''unfavorable'' categories a re discussed. It is concluded that, in its improved structured format, the Glasgow Outcome Scale should remain the primary method of assessi ng outcome in trials of the management of severe head injury.