Glasgow Coma Scale

glasgow coma scale
The Glasgow Coma Scale (GCS) was developed by Graham Teasdale and Bryan Jennett from the Institute of Neurological Sciences at the University of Glasgow in Glasgow, Scotland, UK and published in 1974. The scale is a numerical rating system, originally used for measuring conscious state following a traumatic brain injury. It is now a widely used and recognised assessment tool for reporting any patient’s conscious state during pre-hospital assessment and for monitoring progress. It is only used for adult patients, but other validated rating scales in paediatrics.

The scale uses three categories which pertain to different areas of a person’s conscious state:

  1. Eyes opening
  2. Vocal response
  3. Motor response.

Each area is given a range of numbers that correlate with levels of consciousness which are then
collated to give a score between 3 (deep unconscious) to 15 (normal conscious).

Summary of the Glasgow Coma Scale:
The best response in each category is recorded. It may not be possible to assess in all categories (eg due to eye trauma; drug use)
Eyes Opening:
1. Do not open eyes
2. Open in response to painful stimuli
3. Open in response to voice
4. Open spontaneously

Verbal Response:
1. None
2. Incomprehensible sounds
3. Utters incoherent and inappropriate words
4. Confused and disoriented
5. Oriented to time and converses normally

Motor Response:
1. None
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to a painful stimuli
5. Localizes to pain
6. Obeys commands

Scoring:
Score for eye opening + score for best verbal response + score for best motor response = Glasgow Coma Scale.
Score: 14 – 15 = mild dysfunction
Score: 11- 13 = moderate to severe dysfunction
Score: 10 or less = severe dysfunction

Commentary:

  • The scale has been criticised due to its poor inter-rater reliability and lack of data to support its usefulness for prognosis. The use of the same person to determine the scale each time may help reliability
  • There are some alternatives, but they have not really gained acceptance
  • Drugs and alcohol, shock, or a low blood oxygen can alter a patient’s level of consciousness, limiting the usefulness of the scale

A GCS Aid is available in a number of different languages:



Page last updated: @ 4:25 am

 
Comments are closed.