The Glasgow Coma Scale (GCS) is used in triage in order to determine the traumatic brain injury patients who need a CT scan or neurosurgery. This is a critical decision process because early treatment of brain injury can greatly improve outcome.
A recent study found that nearly one-third of inexperienced doctors (first year junior residents) failed to give an accurate GCS score in traumatic brain injury patients. Two categories were misjudged more significantly than others: 1) the assessment of confused conversation (orientation-impaired but can speak a sentence consisting of more than a couple words) and 2) the assessment of withdrawal motor response (normal flexion, patient's axilla opens following painful stimuli on nail bed or arm).
Since treatment and outcome can depend on an accurate GCS score, knowing the categories that give inexperienced doctors the most challenge will help develop better training programs, and ultimately result in fewer mistakes.
Namiki J, Yamazaki M, Funabiki T, & Hori S. Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians. Clinical Neurology and Neurosurgery. (February 2011).