Default Handling of the Non-Assessable Verbal Glasgow Coma Scale Misclassifies Illness Severity in Mechanically Ventilated Patients: A Retrospective Analysis

The study examined the problem with the Glasgow Coma Scale (GCS), a standard tool for assessing neurological status in intensive care unit patients. In mechanically ventilated patients, the verbal component of GCS cannot be assessed, leading to misclassification of illness severity. The research included 14,230 patients with acute brain injury and found that 45.2% had a non-assessable verbal component and 47.5% of ventilated patients had no assessable verbal score in the first 24 hours. The standard handling method assigned a score of 15 (normal) to 42.9% of patients despite having eye and motor findings consistent with severe illness. Excluding patients with missing data removed 28.5% of patients who accounted for 50.2% of all deaths. The authors recommend explicitly flagging and reporting non-assessable verbal GCS components in illness severity assessment systems.