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Glasgow Coma Scale (GCS) - Modified version

Eye Opening:
  

Verbal Response:
   
Motor Response:
 
Motor response in any limb is acceptable

Background Info


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

References

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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