Reviewing the application of the Glasgow Coma Scale: Does it have interrater reliability?

Abstract

This article explores if the Glasgow Coma Scale (GCS) has interrater reliability. The GCS was proposed as a tool that could be used with confidence by a range of healthcare practitioners. For this to be true the agreement between persons using the GCS should be consistent. This study investigates the evidence to assess if this is the case. This was undertaken with a systematic literature review of mainly electronic journals and healthcare databases. It remains unclear if the GCS has interrater reliability: the evidence base does not show agreement between researchers. Recent research is inconsistent not only in its conclusions but also its research methodologies. The uncertain research relating to interrater reliability contradicts the fundamental principle of the assessment tool (that it could be used with confidence by a range of healthcare professionals). The use of the GCS in adult nursing should be done with the knowledge that the evidence base supports the practitioner. As a result authoritative research is required to assess if the GCS has IR reliability. This is overdue, especially in the UK where the GCS has been part of formal guidance for several years.

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