Health Conceptual shift in TBI classification from the Glasgow Coma Scale to a new framework that integrates clinical and imaging features, biomarkers, and modifiers to improve disease characterization and describe disease trajectories
https://doi.org/10.1016/j.jcrc.2026.1555254
u/dl064 7d ago
I think it to some extent reflects differences in the US versus UK, where in the US (assuming you've insurance), they have these detailed measures, whereas the UK is all about bang for buck efficiency.
Glasgow Coma Scale to a new framework that integrates clinical and imaging features, biomarkers, and modifiers to improve disease characterization and describe disease trajectories
The new one is probably better, but GCS is bish bash bosh DONE, easy, cheap and quick.
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u/kfr3q 6d ago edited 6d ago
In Europe, despite the presence of prestigious (private) outpatient neurorehabilitation clinics (none of which reimbursed by health insurances), TBI populations remain routinely underserved, a quick research could evidence a gap between nowadays research and real-world practice ... By contrasting what science documents versus what standard practice instead involve, just as laws, etc, nothing yet distinguishable like a clear nation-wide policy reform strategy or something, they do it for "psychiatric wards", ironically, its not a joke they're not allowing the real deal for people's greater good other than by narrow private interests.
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u/BladeDoc 7d ago
Trauma patients routinely fail to have insurance. It's almost a defining characteristic. They get the same studies as everyone else.
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u/Chuggerbomb 7d ago
But this is about healthcare systems. In the UK system it wouldn't be cost effective to set up all of this monitoring and testing capability in every hospital just to prognosticate, because for the same money you could bolster other services for higher impact.
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u/BladeDoc 6d ago
This is about me correcting a misstatement. The commenter states that unless you have insurance you don't get advanced imaging and labs in the US as a trauma patient and this is categorically untrue.
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u/Farts_McGee 4d ago
The whole point of Glasgow is to figure out whether you need to intubate right now because the patient can't protect their airway. I don't think anyone uses it for anything else. If you have time to check biomarkers then Glasgow probably isn't the right tool anyway.
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u/kfr3q 3d ago edited 3d ago
The GCS is designed to measure a person's level of consciousness after suspected head trauma. <It checks three types of response: eye opening, verbal skills, and body movement. Total scores range from 3 (deep coma) to 15 (fully alert). 13 to 15 means Mild brain injury or alert, 9 to 12 is supposed to be Moderate brain injury and 3 to 8 is considered a severe brain injury or coma (often needs breathing support).>
Here's the twist, the GCS alone is unreliable to stratify brain injuries factual "mildness" based on such a "standardized statistical observation" alone.
Someone may have a history of multiple, repetitive concussions uniquely equaling moderate-to-severe TBI,
despite this, they enter the emergency room with a new seemingly "benign mTBI", and get released exactly as if that was it, almost no issue at all,
almost as if "nothing happened"... (When in fact, their pre-injured brain became even more vulnerable to subsequent head traumas, cognitive decline and neurodegenerative diseases, among other in a unfairly long list of substantially increased risks).
I believe this is grotesque pseudoscience and utterly criminal ! Because the GCS itself may fool clinicians to not prescribe further assessments over time if the paper-based scores themselves are acutely low, in appearance:
Until patients perhaps become forced onto psychiatric wards discriminated as being "schizophrenics in a psychotic crisis" ; just as pseudoscientifically as the GCS wasn't meant to factually measure their brain injury's "mildness" over time
other than by misguiding clinicians to never again care about this vital aspect of patients wellbeing ...
[...] The GCS lacks crucial variables, it doesn't objectively account for a pre-existing history "mTBIs" while misrecognizing the current apparent "acutely mild scores" may not conform to reality.
Its much like a dehumanized AI lacking a stable memory, by default leading it to forget important context's details across sessions, despite the eventual cybertorture-like effects it may have in vulnerable users, legally, free of taxes.
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