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* GCS 4: Deep coma; Coma Grade III
* GCS 4: Deep coma; Coma Grade III
* GCS 3: Deep coma; Coma Grade IV
* GCS 3: Deep coma; Coma Grade IV
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 [[Pediatric Glasgow Coma Scale]], a separate yet closely related scale, was developed for assessing young children.
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 [[Pediatric Glasgow Coma Scale]], a separate yet closely related scale, was developed for assessing young children.<ref name="www.bt.cdc.gov">{{Cite web  | last =  | first =  | title = Glasgow Coma Scale|Mass Casualties | url = http://www.bt.cdc.gov/masscasualties/gscale.asp | publisher =  | date =  | accessdate = 8 March 2014 }} {{Dead link| date=March 2016}}</ref>
 
<ref name="www.bt.cdc.gov">{{Cite web  | last =  | first =  | title = Glasgow Coma Scale|Mass Casualties | url = http://www.bt.cdc.gov/masscasualties/gscale.asp | publisher =  | date =  | accessdate = 8 March 2014 }} {{Dead link| date=March 2016}}</ref>


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Revision as of 22:43, 26 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2], Sadaf Sharfaei M.D.[3]

Overview

The Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent 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 after head injury, and the scale is now used by first aid, emergency medical services, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in the intensive care. The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital.

Glasgow Coma Scale Calculator

The scale is composed of three tests: eye, verbal and motor responses. The three values separately, as well as their sum, are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Calculation of Glasgow Coma Scale

Glasgow Coma Scale
Variable Score
Motor response Obeys commands
(The patient does simple things as asked.)
6
Localizes to pain (Purposeful movements towards painful stimuli; hand crosses mid-line and gets above clavicle when supra-orbital pressure applied) 5
Flexion/Withdrawal to pain (Flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied; pulls part of body away when nailbed pinched) 4
Abnormal flexion to pain (Flexor posturing: Adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response) 3
Extension to pain (Extensor posturing: Abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response) 2
No motor response 1
Verbal response 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.) 5
Confused (The patient responds to questions coherently but there is some disorientation and confusion) 4
Inappropriate words (Random or exclamatory articulated speech, but no conversational exchange) 3
Incomprehensible sounds (Moaning but no words) 2
No verbal response 1
Eye response Eyes opening spontaneously 4
Eye opening to speech (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.) 3
Eye opening in response to pain stimulus (A peripheral pain stimulus, such as squeezing the lunula area of the patient's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect) 2
No eye opening 1
Glasgow Coma Scale:
Interpretation:

Interpretation of Glasgow Coma Scale

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".[1] Generally when a patient is in a decline of their GCS score, the nurse or medical staff should assess the cranial nerves and determine which of the twelve have been affected. 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". Often the 1 is left out, so the scale reads Ec or Vt.

Brain injury is classified as:

  • GCS 8-15 and somnolence: Sleepy, easy to wake
  • GCS 8-15 and stupor: Hypnoid, hard to wake
  • GCS ≥ 13: Mild Head Injury
  • GCS 9–12: Moderate Head Injury
  • GCS ≤ 8: Severe Head Injury
  • GCS 7-8: Light coma; Coma Grade I
  • GCS 5-6: Light coma; Coma Grade II
  • GCS 4: Deep coma; Coma Grade III
  • GCS 3: Deep coma; Coma Grade IV

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 Pediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing young children.[2]

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Disclaimer

Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glasgow Coma Scale was designed and should be used to assess the depth and duration of coma and impaired consciousness. This scale helps to gauge the impact of a wide variety of conditions such as acute brain damage due to traumatic and/or vascular injuries or infections, metabolic disorders (e.g., hepatic or renal failure, hypoglycemia, diabetic ketosis) etc.[3]

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 centers 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.
  • Meredith W., Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S have proposed calculating the verbal score based on the measurable eye and motor responses.

Controversy

The GCS has come under pressure from some researchers that take issue with the scale's issues, such as poor inter-rater reliability and lack of prognostic utility.[4] Although there is not an agreed upon alternative, newer scores such as the Simplified Motor Scale and FOUR Score have also been developed as improvements to the GCS.[5] While inter-rater reliability of these newer scores have been slightly higher than the GCS, they were not significant enough to gain consensus as a replacement.

See also

References

  1. "http://www.bt.cdc.gov/masscasualties/pdf/glasgow-coma-scale.pdf" (PDF). External link in |title= (help)
  2. "Glasgow Coma Scale". Retrieved 8 March 2014. Text "Mass Casualties " ignored (help)[dead link]
  3. "http://www.bt.cdc.gov/masscasualties/pdf/glasgow-coma-scale.pdf" (PDF). External link in |title= (help)
  4. Green, S. M. (2011). Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of emergency medicine, 58(5), 427_430. Elsevier Inc. doi:10.1016/j.annemergmed.2011.06.009
  5. Iver, VN; Mandrekar, JN; Danielson, RD; Zubkov, AY; Elmer, JL; Wijdicks, EF (2009). "Validity of the FOUR score coma scale in the medical intensive care unit". Mayo Clinic Proceedings. 84 (8): 694–701. PMID 19648386.