Limitations of the use of the Glasgow Coma Scale in intensive care patients with non-neurological primary disease: a search for alternatives

Numerous scoring systems have been devised to assess the severity of illness and predict outcome in critically ill patients in the ICU, many of which incorporate the Glasgow Coma Scale (GCS) as a key component. However, the GCS requires observation of a verbal score (which is often unavailable in the ICU), must be interpreted in cases of concurrent sedation, and is insensitive to more subtle derangements of consciousness (such as delirium). Furthermore, its relationship with outcome may be nonlinear. In this study we quantified the practical limitations of using the GCS in daily routine. We then aimed to provide alternative methods for neurological assessment scoring in case of missing GCS scores.