The Glasgow Coma Scale (GCS) was introduced in 1974 aiming at standardizing assessment of level of consciousness in head injured patients. It has been used mainly in evaluating prognosis, comparing different groups of patients and monitoring the neurological status. However its use expanded beyond the original intention of the scale and certain limitations were identified. The skewness toward the motor subscore, the experience of the raters, the process of intubation, the time and setting of rating among others are to be taken into account. In this review a thorough presentation of this scale's history, principles of scoring and associated common pitfalls, major applications and drawbacks is attempted. Moreover, future trends and implications are considered. The key concept in all articles reviewed is that even though GCS is not a perfect tool and other coma scales have been proposed, it seems destined to be incorporated in clinical decisions regarding coma for many years to come. Nonetheless, deep knowledge of its proper applications on one hand and limitation of its misuse on the other is essential to benefit both health care professionals and their patients.
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