Journal of neurosurgery
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Journal of neurosurgery · Nov 1988
Review Comparative StudyA comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).
The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way. ⋯ The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.
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Journal of neurosurgery · Nov 1988
Review Comparative StudyCurrent reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature.
One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status. ⋯ The lack of standardization makes it unnecessarily difficult to perform valid comparisons between different series of patients. Since the GCS sum score is the most widely used scale, it is suggested that the reporting of the GCS sum score should be standardized regarding pseudoscoring, coma definition, and use of combined scores. Further studies on the reliability of the GCS sum score are needed.
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Journal of neurosurgery · Nov 1988
Case ReportsMycotic vasculitis with repeated intracranial aneurysmal hemorrhage. Case report.
A case of repeated intracranial aneurysmal rupture occurring despite successful treatment of infective endocarditis is reported. While the valvular source of emboli was eradicated and serial angiograms documented no further aneurysms after resection of the primary lesion, the formation and rupture of multiple septic aneurysms occurred 9 months later in the opposite hemisphere. A relationship to damage of the cerebral vasculature by immune complexes is suggested as one possible explanation for this unusual occurrence. This implies that some patients with infective endocarditis may be at permanent risk for the formation and rupture of mycotic intracranial aneurysms, despite successful treatment of the primary cardiac lesion.