Glasgow Outcome Scale Extended
The Glasgow Outcome Scale Extended (GOS-E) is a modified version of the Glasgow Outcome Scale (GOS), which is a simple and widely used tool to measure the outcome of patients with brain injuries. The GOS-E was developed to address some of the limitations of the GOS, such as the use of broad categories that are insensitive to change and the lack of a structured interview format. The GOS-E extends the original 5 GOS categories to 8 and uses a standardized questionnaire to assess the patient’s functioning in various domains.
Categories of Glasgow Outcome Scale Extended
The GOS-E consists of eight categories that describe the level of recovery of a patient after a brain injury:
- Death: The patient died as a result of the injury or its complications.
- Vegetative state: The patient is alive but has no awareness of self or environment and shows no sign of improvement.
- Lower severe disability: The patient is conscious but dependent on others for daily activities and personal care and cannot be left alone for more than 8 hours.
- Upper severe disability: The patient is conscious but dependent on others for daily activities and personal care but can be left alone for more than 8 hours.
- Lower moderate disability: The patient is independent in daily life but has physical, cognitive, or emotional impairments that prevent work or social activities and requires at least an hour of supervision or assistance per day.
- Upper moderate disability: The patient is independent in daily life but has physical, cognitive, or emotional impairments that limit work or social activities and requires less than an hour of supervision or assistance per day.
- Lower good recovery: The patient has resumed normal life but has minor residual problems that interfere with work or social activities.
- Upper good recovery: The patient has resumed normal life but has minor residual problems that do not interfere with work or social activities.
The GOS-E is usually assessed by a clinician or a trained interviewer based on the patient’s medical records, observations, and interviews with the patient and/or family members. The GOS-E can be applied at any time point after the injury, but it is typically used at discharge, 6 months, and 1 year.
How to do an Assessment with GOS-E?
To do an assessment with the GOS-E, you will need the following:
- A copy of the GOS-E questionnaire, which can be found online or in published manuals
- A clinician or a trained interviewer who can administer the questionnaire
- A patient who has suffered a TBI and/or a family member who can provide information about the patient’s status and abilities
- A time point after the injury, such as discharge, 6 months, or 1 year
The steps to do an assessment with the GOS-E are:
- Review the patient’s medical records and observations to get an overview of the patient’s condition and history
- Ask the patient and/or family member about the patient’s current status and abilities in different areas such as mobility, self-care, communication, cognition, social interaction, and work
- Use the criteria and examples provided in the questionnaire to assign a score based on the patient’s functioning in each area
- Use the scoring algorithm provided in the questionnaire to determine the final GOS-E score based on the scores in each area
- Record and report the GOS-E score along with any additional comments or observations
The GOS-E score can help you to monitor the progress and prognosis of the patient and to evaluate the effectiveness of interventions. However, you should also use other measures that can capture the specific aspects of impairment, disability, and quality of life of the patient. You should also be aware of the limitations of the GOS-E, such as its complexity and time-consuming nature, its potential influence by cultural or social factors, its lack of reflection of subjective well-being or satisfaction, and its possible omission of some aspects of impairment or disability.
The GOS-E is a useful and reliable tool to measure the outcome of patients with TBI. It provides a comprehensive and global measure of recovery that can be compared across studies and populations. However, it is not a perfect measure and it should be used in conjunction with other measures that can capture the complexity and diversity of TBI outcomes.
Glasgow Outcome Scale Extended Pediatrics
The Glasgow Outcome Scale Extended Pediatrics (GOS-E Peds) is a tool used to assess the outcome of children, toddlers, and infants who have suffered a traumatic brain injury (TBI). It is a modified version of the Glasgow Outcome Scale Extended (GOS-E), which is designed for adults and older adolescents. The GOS-E Peds is developmentally appropriate and uses a structured interview to classify the patient’s functioning in different domains such as mobility, self-care, communication, cognition, social interaction, and work. The GOS-E Peds consists of eight categories that describe the level of recovery of the patient after a TBI, from death to full recovery. The GOS-E Peds has been shown to have good validity and reliability across a wide age and injury severity spectrum.
Difference Between GOS-E and GOS-E Peds
| Aspect | GOS-E | GOS-E Peds |
|---|---|---|
| Target population | Adults and older adolescents with TBI | Children, toddlers and infants with TBI |
| Interview format | Standard questionnaire | Developmentally appropriate structured interview |
| Category descriptions and examples | General and broad | Detailed and specific |
| Domains of functioning covered | Mobility, self-care, communication, cognition, and social interaction | Children, toddlers, and infants with TBI |
| Validity and reliability | Established for adults and some adolescents | Established for a wide age and injury severity spectrum |
Advantages of GOS-E
The GOS-E has several advantages as an outcome measure:
- It is more sensitive and specific than the GOS
- It covers a broader range of outcomes from death to full recovery
- It captures the quality and quantity of functioning in different domains
- It uses a structured interview to improve reliability and validity
- It is compatible and comparable with the GOS
Limitations of Glasgow Outcome Scale Extended
However, the GOS-E also has some limitations:
- It is more complex and time-consuming than the GOS
- It may still be influenced by cultural or social factors that affect the expectations and perceptions of recovery
- It does not reflect the subjective well-being or satisfaction of the patient
- It may not capture all aspects of impairment or disability such as cognition, emotion, or behavior
The GOS-E and its variants are widely used in clinical practice and research to evaluate the outcome of patients with brain injuries. They provide a comprehensive and global measure of recovery that can be compared across studies and populations. However, they should be complemented by more detailed and specific measures that capture the complexity and diversity of brain injury outcomes.
Conclusion
The Glasgow Outcome Scale Extended (GOS-E) is a useful and reliable tool to measure the outcome of patients with brain injuries. It provides a global and comprehensive assessment of the patient’s functioning in different domains and levels of recovery. It can help clinicians and researchers to monitor the progress and prognosis of the patient and to evaluate the effectiveness of interventions. However, the GOS-E is not a perfect measure and it has some limitations that should be considered. Therefore, it is recommended to use the GOS-E in conjunction with other measures that can capture the specific aspects of impairment, disability, and quality of life of the patient.
FAQs
What is the difference between the GOS and the GOS-E?
The GOS-E is an extended version of the GOS that subdivides the upper three categories of the GOS into eight levels and uses a structured interview to assess the patient’s functioning in various domains.
How do I administer and score the GOS-E?
The GOS-E can be administered by a clinician or a trained interviewer using a standardized questionnaire that can be found online or in published manuals. The interviewer should ask the patient and/or family members about the patient’s current status and abilities in different areas such as mobility, self-care, communication, cognition, social interaction, and work. The interviewer should then assign a score based on the criteria and examples provided in the questionnaire.
How do I interpret the GOS-E score?
The GOS-E score ranges from 1 to 8, with higher scores indicating better outcomes. The score reflects the level of recovery of the patient after a brain injury, from death to full recovery. The score can also be grouped into three broad categories: severe disability (1-4), moderate disability (5-6), and good recovery (7-8).
What are the advantages and limitations of the GOS-E?
The advantages of the GOS-E are that it is more sensitive and specific than the GOS, it covers a broader range of outcomes from death to full recovery, it captures the quality and quantity of functioning in different domains, it uses a structured interview to improve reliability and validity, and it is compatible and comparable with the GOS.
The limitations of the GOS-E are that it is more complex and time-consuming than the GOS, it may still be influenced by cultural or social factors that affect the expectations and perceptions of recovery, it does not reflect the subjective well-being or satisfaction of the patient, and it may not capture all aspects of impairment or disability such as cognition, emotion or behavior.
References
(1) Introduction to the Extended Glasgow Outcome Scale.
(2) A Manual for the Glasgow Outcome Scale-Extended Interview.
(3) Glasgow Outcome Scale – Extended | RehabMeasures Database.
(4) Glasgow Outcome Scale – Wikipedia.
(5) Glasgow Outcome Scale – an overview | ScienceDirect Topics.