Glasgow Outcome Scale GOS And GOS-E

Evaluates neurological function in patients with traumatic brain injury.

In the text below the tool there is more information about the two versions of the scale.

The Glasgow outcome scale assesses patients with traumatic brain injury in terms of neurological status and degree of disability.

This clinical decision making tool has 2 versions of the scale, the original and the extended version.

The original GOS was devised by Jennett and Bond in 1975 to provide a standardized method of evaluating cerebral trauma. There are five statuses that aim to award an objective assessment of recovery.

The extended version benefits from eight statuses, because of a separation between lower and upper function.

Both scales can be used in long term prediction of rehabilitation after traumatic brain injury.


Glasgow Outcome Scale

1 Dead
2 Persistent Vegetative State
Patient exhibits no obvious cortical function.
3 Severe Disability (Conscious but disabled)
Patient depends upon others for daily support due to mental or physical disability or both.
4 Moderated Disability (Disabled but independent)
Patient is independent as far as daily life is concerned. The disabilities found include varying degrees of dysphasia, hemiparesis, or ataxia, as well as intellectual and memory deficits and personality changes.
5 Recovery
Resumption of normal activities even though there may be minor neurological or psychological deficits.

Glasgow Outcome Scale - Extended Version

1 Dead
2 Vegetative State
Condition of unawareness with only reflex responses but with periods of spontaneous eye opening.
3 Low Severe Disability
4 Upper Severe Disability
Patient who is dependent for daily support for mental or physical disability, usually a combination of both. If the patient can be left alone for more than 8h at home it is upper level of SD, if not then it is low level of SD.
5 Low Moderate Disability
6 Upper Moderate Disability
Patients have some disability such as aphasia, hemiparesis or epilepsy and/or deficits of memory or personality but are able to look after themselves. They are independent at home but dependent outside. If they are able to return to work even with special arrangement it is upper level of MD, if not then it is low level of MD.
7 Low Good Recovery
8 Upper Good Recovery
Resumption of normal life with the capacity to work even if pre-injury status has not been achieved. Some patients have minor neurological or psychological deficits. If these deficits are not disabling then it is upper level of GR, if disabling then it is lower level of GR.
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About GOS and GOS-E

There are two Glasgow outcome scales, an original version and an extended one. These are presented above one after another to offer clinicians a rapid but extensive stratification tool for the assessment of patients with traumatic brain injury.

The GOS was first described in 1975 in a study by Jennet and Bond. It consists of five statuses that make up an objective evaluaton for initial status and recovery. GOS has also been used successfully in predicting the long term rehabilitation after TBI.

The Extended Glasgow Outcome Scale or GOS-E was meant to address the shortfalls of the original version and consists of eight statuses and a structured interview to be applied with it.

GOS-E has shown more reliability and content validity in practice. The GOS-E is more sensitive than GOS in terms of changes in mild and moderate traumatic brain injuries.

Both of these scales provide a general assessment of mental function, trauma severity and outcome after head injury. In research of traumatic injury GOS are recommended to be administered at 3, 6 and 12 months.

For patients with TBI there are also rehabilitation models available, like the Disability Rating Scale that consists of interview questions that offer information about the patient status, rehabilitation and perceived disability.


Traumatic Brain Injury (TBI)

TBI is a type of intracranial injury caused by external trauma to the head, usually in accidents, assaults or falls.

TBIs are classified by severity and vary from minor concussion to severe brain injury, dependent on the injury mechanism (closed or penetrating), location and patient variables.

Symptoms depend on the severity of the brain damage.

The following table explains the correlation with the Glasgow coma scale scores and the main characteristics:

TBI injury severity Symptoms Glasgow Coma Scale Post Traumatic Amnesia Loss of consciousness
Mild Headaches, confusion, dizziness, fatigue, blurred vision, behavioural changes 13 - 15 <1 day amnesia
0 – 30 min LOC
Moderate All symptoms from mild but worse, seizures, restlessness, slurred speech 9 – 12 <7 day amnesia
>30 minutes - 24h LOC
Severe More severe symptoms than moderate TBI, inability to be awoken from sleep, numbness in extremities, convulsions, loss of coordination, mental degradation, coma 3 - 8 >7 day amnesia
>24h LOC

Original source

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1(7905):480-4.

Other references

1. Wilson JTL, Pettigrew LEL, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for their use. Journal of Neurotrauma. 1998; 15:573-585.

2. Weir J et al. Does the Extended Glasgow Outcome Scale Add Value to the Conventional Glasgow Outcome Scale? J Neurotrauma. 2012; 29(1): 53–58.

3. Levin HS, Boake C, Song J, Mccauley S, Contant C, Diaz-Marchan P, Brundage S, Goodman H, Kotrla KJ. Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury. J Neurotrauma. 2001; 18(6):575-84.

Specialty: Emergency

Objective: Evaluation

Type: Scale

No. Of Items: 5 and 8

Year Of Study: 1975

Abbreviation: GOS and GOS-E

Article By: Denise Nedea

Published On: June 21, 2017

Last Checked: June 21, 2017

Next Review: June 21, 2023