Modifications of Glasgow Coma Scale—a Systematic Review

Glasgow coma scale has been the mainstay of scoring traumatic brain injury patients for nearly five decades. It has seen several modifications based on various parameters; which include age, pupils, and brainstem reflexes. The objective of this article was to systematically review all the modifications of the Glasgow coma scale in the English literature by searching PubMed and Scopus. We searched using the keywords “Glasgow coma scale modification” and “pediatric coma scales” in the PubMed and Scopus search string from inception until 15 August 2022. The manuscript excludes articles not related to scoring, articles dedicated to non-traumatic brain injury patients, case reports and opinions, and articles lacking full-length and non-English texts. The search yielded 5718 articles of which 54 were eligible. The modifications were based on age, brainstem reflexes, motor score alone, serum factors, etc. The use of the majority of 54 eligible articles was limited to the index centers that have designed them; however, the pediatric Glasgow coma score and the Full Outline of Unresponsiveness score hold promise.