Difference and efficacy of simplified motor scale compared to Glasgow coma scale


  • Tammam Mozher Aldarwish Department of Emergency Medicine, King Fahad Genreal Hospital, Jeddah, Saudi Arabia
  • Mohammed Abdulaziz Alowaidhi Department of Intensive Care Unit, Hera General Hospital, Mecca, Saudi Arabia
  • Naish Abdullah Alghamdi Department of Intensive Care Unit, Ahad Rufaidah General Hospital, Abha, Saudi Arabia
  • Ahmed Mohammed Al Hammad Department of Emergency Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
  • Mohammed Ibrahim Aljikhlib Department of Internal Medicine, General Network of Healthcare Providers, Jeddah, Saudi Arabia
  • Mohammad Mosa Alkhadhrawi College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  • Adil Ibrahim Hanbashi Department of Neurosurgery, King Fahad Central Hospital, Jazan, Saudi Arabia
  • Ammar Yarmohammed Bakhsh Department of Emergency Medicine, King Faisal Hospital, Mecca, Saudi Arabia
  • Fatimah Falah Al Matar College of Medicine, Medical University of Warsaw, Warsaw, Poland
  • Amnah Saeed Al Saffar Department of Emergency Medicine, Dammam Medical Complex, Dammam, Saudi Arabia
  • Ammar Zakaria Faloudah College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia




GCS, SMS, Coma, Emergency


There have been many limitations reported with using the Glasgow coma scale (GCS), including complexity, and being difficult to apply among aphasic, intubated, and pediatric patients. Accordingly, many researchers exerted serious efforts to enhance and modify the scale to make it more applicable and easy to interpret in these settings. The simplified motor score (SMS) was reported in the literature in 2012 for the assessment of patients with coma in different traumatic and non-traumatic settings. In the present study, we have discussed the findings of previous studies in the literature that compared the efficacy between the SMS and GCS in the assessment of patients with traumatic brain injuries within the emergency department and out-patient settings. Our results indicate the efficacy of the SMS is similar to that of the GCS score in predicting the different outcomes, including functional performance, need to perform tracheal intubation and hospital admission. Nevertheless, evidence regarding the prediction of mortality seems to be inconsistent across the different investigations. However, the differences between the two scores is not remarkable among these studies, indicating that the SMS is an efficacious tool in this regard within an acceptable test performance results. Furthermore, the SMS score can be easily applied within these without performing complex approaches, which makes it more advantageous than the GCS. However, this evidence is based on a limited number of investigations, and more studies are required.


Hifumi T, Kuroda Y, Kawakita K. Effect of Admission Glasgow Coma Scale Motor Score on Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Therapeutic Hypothermia. Circulation j. 2015;79(10):2201-8.

Handschu R, Haslbeck M, Hartmann A. Mortality prediction in critical care for acute stroke: Severity of illness-score or coma-scale? J neurol. 2005;252(10):1249-54.

McNett M. A review of the predictive ability of Glasgow Coma Scale scores in head-injured patients. J neurosci. 2007;39(2):68-75.

Singh B, Murad MH, Prokop LJ. Meta-analysis of Glasgow coma scale and simplified motor score in predicting traumatic brain injury outcomes. Brain injury. 2013;27(3):293-300.

Caterino JM, Raubenolt A. The prehospital simplified motor score is as accurate as the prehospital Glasgow coma scale: analysis of a statewide trauma registry. Emergency med j. 2012;29(6):492-6.

Tuhrim S, Dambrosia JM, Price TR. Prediction of intracerebral hemorrhage survival. Ann neurol. 1988;24(2):258-63.

Fu X, Wong KS, Wei JW. Factors associated with severity on admission and in-hospital mortality after primary intracerebral hemorrhage in China. Int j. 2013;8(2):73-9.

Jina L, Yangb P, Zhang Y. Prediction Values of the Simplified Motor Score and the Glasgow Coma Scale Motor Component for the Clinical Outcomes of Intracranial Hemorrhage. 2021.

Jamil SA, Khan AS, Akturk Z. Predictors of outcome for non-traumatic intracerebral hemorrhage. Neurosciences (Riyadh, Saudi Arabia). 2008;13(3):263-7.

Cho DY, Wang YC. Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome. Intensive care med. 1997;23(1):77-84.

Grmec S, Gasparovic V. Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality. Acute Physiology and Chronic Health Evaluation. Mainz Emergency Evaluation System. Cri care. 2001;5(1):19-23.

Rowley G, Fielding K. Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet. 1991;337(8740):535-8.

Holdgate A, Ching N, Angonese L. Variability in agreement between physicians and nurses when measuring the Glasgow Coma Scale in the emergency department limits its clinical usefulness. Emergency med Australasia. 2006;18(4):379-84.

Buechler CM, Blostein PA, Koestner A, Hurt K, Schaars M, McKernan J. Variation among trauma centers' calculation of Glasgow Coma Scale score: results of a national survey. J Trauma. 1998;45(3):429-32.

Green SM. Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale. Ann emergency med. 2011;58(5):427-30.

Buitendag JJP, Ras A, Kong VY. Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa. South Afri med j. 2018;108(2):90-3.

Wang JP, Su YY, Liu YF, Liu G, Fan LL, Gao DQ. Study of Simplified Coma Scales: Acute Stroke Patients with Tracheal Intubation. Chin med j. 2018;131(18):2152-7.

Gill M, Windemuth R, Steele R, Green SM. A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes. Ann emergency med. 2005;45(1):37-42.

Ting HW, Chen MS, Hsieh YC, Chan CL. Good mortality prediction by Glasgow Coma Scale for neurosurgical patients. J Chin Med Asso. 2010;73(3):139-43.

Gill MR, Reiley DG, Green SM. Interrater reliability of Glasgow Coma Scale scores in the emergency department. A emergency med. 2004;43(2):215-23.

Healey C, Osler TM, Rogers FB. Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma. 2003;54(4):671-8.

Al-Salamah MA, McDowell I, Stiell IG. Initial emergency department trauma scores from the OPALS study: the case for the motor score in blunt trauma. Academic emergency med. 2004;11(8):834-42.

Ross SE, Leipold C, Terregino C, O'Malley KF. Efficacy of the motor component of the Glasgow Coma Scale in trauma triage. J Trauma. 1998;45(1):42-4.

Meredith W, Rutledge R, Hansen AR. Field triage of trauma patients based upon the ability to follow commands: a study in 29,573 injured patients. J Trauma. 1995;38(1):129-35.

Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Anna neurol. 2005;58(4):585-93.

Fischer M, Rüegg S, Czaplinski A. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Critical care. 2010;14(2):R64.

Van de Voorde P, Sabbe M, Rizopoulos D. Assessing the level of consciousness in children: a plea for the Glasgow Coma Motor subscore. Resuscitation. 2008;76(2):175-9.

Riechers RG, 2nd, Ramage A, Brown W. Physician knowledge of the Glasgow Coma Scale. J neurotrauma. 2005;22(11):1327-34.

McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale. Anaesthesia. 2004;59(1):34-7.

Jennett B. The Glasgow Coma Scale: History and current practice. Trauma. 2002;4(2):91-103.




How to Cite

Aldarwish, T. M., Alowaidhi, M. A., Alghamdi, N. A., Hammad, A. M. A., Aljikhlib, M. I., Alkhadhrawi, M. M., Hanbashi, A. I., Bakhsh, A. Y., Matar, F. F. A., Saffar, A. S. A., & Faloudah, A. Z. (2021). Difference and efficacy of simplified motor scale compared to Glasgow coma scale. International Journal Of Community Medicine And Public Health, 9(1), 327–331. https://doi.org/10.18203/2394-6040.ijcmph20214787



Review Articles