GCS2: Generating Clinical Standards with the Glasgow Coma Scale

Principal Co-Investigators

  • Susan Khan, RN
  • Daphne Stannard, RN, PhD, FCCM


  • Courtney Trump, RN
  • Catherine Enriquez, RN
  • Karen Chisholm, RN

The Glasgow Coma Scale (GCS) was introduced by Teasdale and Jennett in 1974 as a tool to aid in objectively measuring the neurological status of a patient.

The GCS has achieved international acceptance and continues to be widely used, although studies have shown that it can be used  inconsistently by HCWs and clinical data can be mis-interpreted (Edwards, 2001; Ingram, 1994; Waterhouse, 2009). There have been unsuccessful attempts to replace or supplement the GCS with alternative tools, such as the Full Outline of Unresponsiveness tool (FOUR) (Fischer, 2010). The GCS remains the gold standard for neurologic screening and is built into APEX, the new electronic health record for UCSF Medical Center. 

To ensure standardization of the use of this tool, the research team has created a pre- and post-survey to assess knowledge of the GCS and application of the GCS using clinical scenarios and an educational program that will be available to nurses who consent to be in the study. In addition, there is a brief demographic section to the survey on the pre-survey only.