The Glasgow Outcome Scale — 40 years of application and refinement

Key Points

  • The Glasgow Outcome Scale (GOS) in its original and extended form assesses disability and social participation and is the most highly cited outcome measure in studies on brain injury

  • The GOS is widely used as a primary outcome measure, and is recommended by several national bodies, including the NIH in the USA, and the Department of Health in the UK

  • The GOS can be administered in various ways: face-to-face or telephone interview, mail, and, with a modified version, in inpatient settings; this flexibility leads to high rates of follow-up

  • The GOS is freely available, simple to use and requires little training, has been validated, is reliable, and adult and paediatric versions are available

  • The GOS is the most popular clinician-reported outcome assessment for randomized clinical trials in acute head injury, and has been used in >90% of the most methodologically robust trials

  • Extensive use of the GOS over 40 years has led to interest in the development of composite measures that include the GOS to improve the assessment of brain injury outcome

Abstract

The Glasgow Outcome Scale (GOS) was first published in 1975 by Bryan Jennett and Michael Bond. With over 4,000 citations to the original paper, it is the most highly cited outcome measure in studies of brain injury and the second most-cited paper in clinical neurosurgery. The original GOS and the subsequently developed extended GOS (GOSE) are recommended by several national bodies as the outcome measure for major trauma and for head injury. The enduring appeal of the GOS is linked to its simplicity, short administration time, reliability and validity, stability, flexibility of administration (face-to-face, over the telephone and by post), cost-free availability and ease of access. These benefits apply to other derivatives of the scale, including the Glasgow Outcome at Discharge Scale (GODS) and the GOS paediatric revision. The GOS was devised to provide an overview of outcome and to focus on social recovery. Since the initial development of the GOS, there has been an increasing focus on the multidimensional nature of outcome after head injury. This Review charts the development of the GOS, its refinement and usage over the past 40 years, and considers its current and future roles in developing an understanding of brain injury.

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T.M. co-ordinated the article. All authors made substantial contributions to writing the article and discussion of the content, and reviewed and/or edited the manuscript before submission.

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McMillan, T., Wilson, L., Ponsford, J. et al. The Glasgow Outcome Scale — 40 years of application and refinement. Nat Rev Neurol 12, 477–485 (2016). https://doi.org/10.1038/nrneurol.2016.89

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