Glasgow Coma Scale (GCS) - Modified version
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Eye Opening:
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Verbal Response:
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Motor Response:
Motor response in any limb is acceptable |
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Background Info
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Glasgow Coma Scale Scoring (GCS):
The GCS is composed of three elements:
Eye opening:
Unable to determine (facial swelling, damage, etc) - 1c (c ="closed")
Does not open eyes - 1 point
Opens eyes in response to pain - 2 points
Opens eyes in response to voice - 3 points
Opens eyes spontaneously - 4 points
Verbal response:
Intubated: 1t (t= "tube")
Makes no sounds - 1 point
Makes
Incomprehensible sounds (moaning etc) - 2 points
Words (inappropriate) - 3 points
(Random or exclamatory articulated speech, but no
conversational exchange.)
Confused, disoriented - 4 points
Oriented, converses normally - 5 points
Motor Response:
Makes no movements - 1 point
Extension to painful stimuli (decerebrate response) - 2 points
Abnormal flexion to painful stimuli (decorticate response) - 3
points
Flexion / Withdrawal to painful stimuli - 4 points
Localizes to painful stimuli - 5 points
Obeys commands - 6 points
Glasgow Coma Scale (GCS) - Key Points
- Neurological scale created with the goal of producing a reliable and objective way of
recording the conscious state of a person for initial as well as
subsequent assessment. The initial score could change radically over time
depending on the condition of the patient. Ongoing assessment is
critical.
- Scores range from 0 ( unconsciousness, coma, etc) to 15 (no 'initial' impairment
or fully awake- patient still needs to be closely monitored).
- The GCS is frequently used in the monitoring of critical care patients
and is part of several ICU scoring systems, including the APACHE II, SAPS
II, and SOFA score.
- The original Glasgow Coma Scale had a 14-point scale and omitted the
category of "abnormal flexion." The15-point scale (also known
as the Modified Glasgow Coma Scale) is the most frequently used
version.
- The GCS has limited applicability to children (especially below the age of 36
months) because of the inherent verbal limitations. A pediatric version
was created for this population - Pediatric Glasgow Coma Scale.
- Some researchers have found that the GCS has poor inter-rater reliability and
diminished prognostic utility. Alternatives include newer scores such as the
Simplified motor
scale and FOUR score, although the inter-rater reliability of
these newer scores has been slightly higher than that of the GCS, they
have not gained consensus as replacements.
Scoring and Interpretation:
Individual elements
are just as important and should be listed as well as the final sum.
Example:
GCS 8 = E2 V3 M3 at 09:15
If the patient's eyes are closed due to trauma and the same patient is
intubated:
GCS 5 = E1t V1t M3 at 09:15
Scoring:
Severe Head/Brain Injury: GCS </= 8
Moderate Head/Brain Injury: GCS 9 -12
Minor, Mild Head/Brain Injury: GCS 13-14
Fully awake/ Normal -periodically reassess: GCS 15
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References
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1] Teasdale G, Jennett B (1974). "Assessment
of coma and impaired consciousness. A practical scale". Lancet.
2 (7872): 81–4.
[Pubmed]
2]
Gill M, Windemuth R, Steele R, Green SM (2005). "A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes". Ann Emerg Med. 45 (1): 37–42.
3]
Green S. M. (2011). "Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale". Annals of Emergency Medicine. 58 (5): 427–430.
[Pubmed]
4] Fischer, M; Rüegg, S; Czaplinski, A; Strohmeier, M; Lehmann, A; Tschan,
F; Hunziker, PR. (2010) "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. 14 (2): R-64.
[Pubmed]
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