In 1974 the Institute of Neurological Sciences, Glasgow, was a world leader in brain injury research and clinical care. Professor Jennett and Mr Teasdale, (at that time a neurosurgical senior registrar), published a paper in the Lancet on the Assessment of Coma and Impaired Consciousness that proposed a structured method of assessment that would become known as the Glasgow Coma Scale. Forty years on, Sir Graham led a project to understand the current use of the Glasgow Coma Scale, its successes and its perceived shortcomings.
Patient archives were reviewed to identify the number of admissions and procedures performed at the Institute of Neurological Sciences, Glasgow, in the years 1988, 1997 and 2011. Death certificate records were used to identify mortality in the unit in the year 2011. Patient records were used to obtain details of diagnosis, time from admission to death, and the presence and timing of a TLD.
The results show an increase in the use of TLDs, with decisions made for 89% of those who died in 2011, compared to 68% in 1997 and 51% in 1988. The number of admissions has increased substantially since 1988 as has the percentage of patients undergoing surgery (46, 67 and 72% in 1988, 1997 and 2011, respectively).
There is a trending increase in the number of patients who have a TLD in this regional neurosurgical unit. This demonstrates an increased willingness of clinicians to recognise poor prognosis and to withdraw or withhold treatment in these cases. Continued appropriate use of the TLD is recommended but it is to only ever reflect the best interests of the patient 1).
Queen Elizabeth University Hospital, Glasgow, United Kingdom