GOS is used to assess the general functioning of the patient who sufferred a traumatic brain injury and to categorize their outcome. It is named for Glasgow, Scotland where its use was first described. It is a five-point score given to victims at some point in their recovery and it is often used in research to quantify the level of recovery patients have achieved. Lower scores indicating a poorer functional outcome. More specific and detailed grading, extended GOS (GOS-E) was used in the recent DECRA trial.
In research, common time points to evaluate the GOS include 3 months, 6 months and 12 months after injury.
GOS:1. Dead
2. Vegetative State - patient is unable to interact with environment and unresponsive, but alive; a "vegetable" in lay language.-Patient show no evidence of meaningful responsiveness. Patients who obey even simple commands, or who utter any words are assigned to the better category of severe disability. Vegetative patietns breathe spontaneously, have periods of spontaneous eye-opening when they may follow moving objects with their eyes, show reflex responses in their limbs (to postural or painful stimuli), and they may swallow food placed in their mouths. This state must be distinguished from other wakeful, reduce responsiveness such as the lock-in-syndrome, akinetic mutism and total global aphasia.
3. Severely Disabled - conscious, able to follow commands but the patient requires others for daily support due to disability.-This indicates that a patient is conscious but needs the assistance of another person for some activities of daily living every day. This may range from continuous total dependency (for feeding and washing) to the need for assistance with only one activity such as dressing, getting out of bed or moving about the house, or going outside to a shop. Often dependency is due to combination of physical and mental disability because when physical disability is severe after head injury there is almost always considerable mental deficit. The patient cannot be left overnight because they would be unable to plan their meals or to deal with callers, or any domestic crisis which might arise. The severely disabled are described by the phrase "conscious but dependent".
4. Moderately Disabled - the patient is independent but unable to return to work or school.-These patients may be summarized as "independent but disabled", but it is perhaps the least easily described category of survivor. Such a patient is able to look for himself at home, to get out and about to the shops and to travel by public transport. However, some previous activities either at work or in social life are now no longer possible by reason of either physical or mental deficit. Some patients in this category are able to return to certain kinds of work, even to their own job if this happens not to involve a high level of performance in the area of their major deficit.
5. Good recovery - the patient has resumed most normal activities and able to return to work or school but may have minor residual problems.-This indicates the capacity to resume normal occupational and social activities, although there may be minor physical or mental deficits. However for various reasons the patient may not have resumed all his previous activities and in particular may not be working.
comment: it is rather a coarse scale with only 5 levels, it has been argued that this scale is not ideal for research purposes.
The extended GOS or GOS-E has extended scale to an 8 level score:1. Dead
2. Vegetative State
3. Lower Severe Disability
4. Upper Severe Disability
5. Lower Moderate Disability
6. Upper Moderate Disability
7. Lower Good Recovery
8. Upper Good Recovery
comment: GOS-E was developed to address the limitations of the original GOS. A structured interview has been provided to improve reliability of rating. Good interrater reliability and content validity have been demonstrated for the GOS-E. Compare to GOS, GOS-E has been shown to be more sensitive to change in mild to moderate TBI.
In research, common time points to evaluate the GOS include 3 months, 6 months and 12 months after injury.
GOS:1. Dead
2. Vegetative State - patient is unable to interact with environment and unresponsive, but alive; a "vegetable" in lay language.-Patient show no evidence of meaningful responsiveness. Patients who obey even simple commands, or who utter any words are assigned to the better category of severe disability. Vegetative patietns breathe spontaneously, have periods of spontaneous eye-opening when they may follow moving objects with their eyes, show reflex responses in their limbs (to postural or painful stimuli), and they may swallow food placed in their mouths. This state must be distinguished from other wakeful, reduce responsiveness such as the lock-in-syndrome, akinetic mutism and total global aphasia.
3. Severely Disabled - conscious, able to follow commands but the patient requires others for daily support due to disability.-This indicates that a patient is conscious but needs the assistance of another person for some activities of daily living every day. This may range from continuous total dependency (for feeding and washing) to the need for assistance with only one activity such as dressing, getting out of bed or moving about the house, or going outside to a shop. Often dependency is due to combination of physical and mental disability because when physical disability is severe after head injury there is almost always considerable mental deficit. The patient cannot be left overnight because they would be unable to plan their meals or to deal with callers, or any domestic crisis which might arise. The severely disabled are described by the phrase "conscious but dependent".
4. Moderately Disabled - the patient is independent but unable to return to work or school.-These patients may be summarized as "independent but disabled", but it is perhaps the least easily described category of survivor. Such a patient is able to look for himself at home, to get out and about to the shops and to travel by public transport. However, some previous activities either at work or in social life are now no longer possible by reason of either physical or mental deficit. Some patients in this category are able to return to certain kinds of work, even to their own job if this happens not to involve a high level of performance in the area of their major deficit.
5. Good recovery - the patient has resumed most normal activities and able to return to work or school but may have minor residual problems.-This indicates the capacity to resume normal occupational and social activities, although there may be minor physical or mental deficits. However for various reasons the patient may not have resumed all his previous activities and in particular may not be working.
comment: it is rather a coarse scale with only 5 levels, it has been argued that this scale is not ideal for research purposes.
The extended GOS or GOS-E has extended scale to an 8 level score:1. Dead
2. Vegetative State
3. Lower Severe Disability
4. Upper Severe Disability
5. Lower Moderate Disability
6. Upper Moderate Disability
7. Lower Good Recovery
8. Upper Good Recovery
comment: GOS-E was developed to address the limitations of the original GOS. A structured interview has been provided to improve reliability of rating. Good interrater reliability and content validity have been demonstrated for the GOS-E. Compare to GOS, GOS-E has been shown to be more sensitive to change in mild to moderate TBI.
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