Glasgow Coma Scale

	Email		Print
	Bookmark		Link

Glasgow Coma Scale

The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological

Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
scale

Scale (ratio)

The concept of scale is applicable if a system is represented Proportionality ly by another system. For example, for a scale model of an object, the ratio of corresponding lengths is a Dimensionless number scale, e.g....
which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).

GCS was initially used to assess level of consciousness

Level of consciousness

Level of consciousness is a measurement of a person's arousal and responsiveness to Stimulus from the environment. A mildly depressed level of consciousness may be classed as lethargy; someone in this state can be aroused with little difficulty....
after head injury

Head injury

Head injury refers to Physical trauma to the head . This may or may not include injury to the human brain . However, the terms traumatic brain injury and head injury are often used interchangeably in the medical literature....
, and the scale is now used by first aid

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by a layman to a sick or injured Casualty until definitive medical treatment can be accessed....
, EMS

Emergency medical services

Emergency medical services are a branch of Emergency services dedicated to providing out-of-hospital Acute and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency....
and doctors

Physician

Discussion

Ask a question about 'Glasgow Coma Scale'

Start a new discussion about 'Glasgow Coma Scale'

Answer questions from other users

Full Discussion Forum

Encyclopedia

The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological

Neurology

Scale (ratio)

Level of consciousness

Head injury

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by a layman to a sick or injured Casualty until definitive medical treatment can be accessed....
, EMS

Emergency medical services

Physician

A physician, medical practitioner, doctor of medicine, or medical doctor practices medicine, and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury....
as being applicable to all acute medical and trauma patients. In hospital it is also used in chronic patient monitoring, in for instance, intensive care.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow

University of Glasgow

The University of Glasgow was founded in 1451, in Glasgow, Scotland, and, along with its contemporary institution, the University of St Andrews, it formed the Kingdom of Scotland's equivalent to Oxbridge....
. The pair went on to author the textbook Management of Head Injuries (FA Davis 1981, ISBN 0-8036-5019-1), a celebrated work in the field.

GCS is used as part of several ICU scoring systems

ICU scoring systems

There are several scoring systems in intensive care units today....
, including APACHE II

APACHE II

APACHE II is a severity of disease classification system , one of several ICU scoring systems. After admission of a patient to an intensive care unit, an integer score from 0 to 71 is computed based on several measurements; higher scores imply a more severe disease and a higher risk of death....
, SAPS II

SAPS II

SAPS II is a severity of disease classification system . Its name stands for "Simplified Acute Physiology Score", and is one of several ICU scoring systems....
, and SOFA

SOFA Score

The Sequential Organ Failure Assessment score, or just SOFA score, is used to track a patient's status during the stay in an intensive care unit ....
, to assess the status of the central nervous system

Central nervous system

The central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of multicellular organisms....
. A similar scale, the Rancho Los Amigos Scale

Rancho Los Amigos Scale

The Rancho Los Amigos Scale is a medical scale intended to assess the level of recovery of brain injury patients and those recovering from coma....
is used to assess the recovery of traumatic brain injury

Traumatic brain injury

Traumatic brain injury occurs when an outside force physical trauma the brain. TBI can be classified based on severity, mechanism , or other features ....
patients.

Elements of the scale

Glasgow Coma Scale
	1	2	3	4	5	6
Eyes	Does not open eyes	Opens eyes in response to painful stimuli	Opens eyes in response to voice	Opens eyes spontaneously	N/A	N/A
Verbal	Makes no sounds	Incomprehensible sounds	Utters inappropriate words	Confused, disoriented	Oriented, converses normally	N/A
Motor	Makes no movements	Extension to painful stimuli	Abnormal flexion to painful stimuli	Flexion / Withdrawal to painful stimuli	Localizes painful stimuli	Obeys commands

The scale comprises three tests: eye

Visual perception

Visual perception is the ability to interpret information from visible light reaching the eye. The resulting perception is also known as eyesight, sight or vision....
, verbal and motor

Motor skill

A motor skill is a learned series of movements that combine to produce a smooth, efficient action.* Gross motor skills include lifting one's head, rolling over, sitting up, balancing, crawling, and walking....
responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma

Coma

In medicine, a coma is a profound state of unconsciousness. A comatose person cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions....
or death

Death

Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....
), while the highest is 15 (fully awake person).

Best eye response (E)

There are 4 grades starting with the most severe:

No eye opening
Eye opening in response to pain
Pain

Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm....
. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital
Supraorbital ridge

The supraorbital ridge, or brow ridge, refer to a bony ridge located above the eye sockets of all primates. In Human the eyebrows are located on their lower margin....
and sternal
Sternum

The sternum is a long flat bone located in the center of the chest . It connects to the rib via cartilage, forming the rib cage with them, and thus helps to protect the lungs, heart and major blood vessels from physical trauma....
pressure or rub may be used.)
Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
Eyes opening spontaneously

Best verbal response (V)

There are 5 grades starting with the most severe:

No verbal response
Incomprehensible sounds. (Moaning but no words.)
Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Best motor response (M)

There are 6 grades starting with the most severe:

No motor response
Extension to pain (adduction
Adduction

Adduction is a movement which brings a limb ? arm or leg ? closer to the Sagittal#Planes of the body. It is opposed to abduction .This term is also used in reference to the operation of the muscle in anatomy or musculature....
of arm, internal rotation of shoulder, pronation
Pronation

In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar joint and talocalcaneonavicular joints....
of forearm, extension
Extension (kinesiology)

Extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved....
of wrist, decerebrate response)
Abnormal flexion to pain (adduction
Adduction

Adduction is a movement which brings a limb ? arm or leg ? closer to the Sagittal#Planes of the body. It is opposed to abduction .This term is also used in reference to the operation of the muscle in anatomy or musculature....
of arm, internal rotation of shoulder, pronation
Pronation

In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar joint and talocalcaneonavicular joints....
of forearm, flexion
Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position....
of wrist, decorticate response)
Flexion/Withdrawal to pain (flexion
Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position....
of elbow, supination
Supination

Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "Genu varum" with their weight supported primarily on the anterior of their feet....
of forearm, flexion
Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position....
of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle
Clavicle

In human anatomy, the clavicle or collar bone is classified as a flat bone that makes up part of the shoulder girdle . It receives its name from the Latin clavicula because the bone rotates along its axis like a key when the shoulder is Abduction ....
when supra-orbital pressure applied.)
Obeys commands. (The patient does simple things as asked.)

Interpretation

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35".

Generally, brain injury is classified as:

Severe, with GCS = 8 - that is also a generally accepted definition of a coma
Moderate, GCS 9 - 12
Minor, GCS = 13.

Intubation

In medicine, intubation refers to the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopy procedures, it is most often used to denote tracheal intubation....
and severe facial/eye swelling or damage, make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached e.g. 'E1c' where 'c' = closed, or 'V1t' where t = tube. A composite might be 'GCS 5tc'. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'.

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently the Paediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.

Revisions

Glasgow Coma Scale: While the 15 point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14 point scale, omitting the category of 'abnormal flexion'. Some centres still use this older scale, but most (including the Glasgow unit where the original work was done) have adopted the modified one.
The Rappaport Coma/Near Coma Scale made other changes.

Glasgow Coma Scale

Elements of the scale

Best eye response (E)

Best verbal response (V)

Best motor response (M)

Interpretation

Revisions

See also

External links