Glasgow coma scale

A widely-used scale for the evaluation of injuries to the brain or nervous system, first proposed1 in 1974. Typically patients are scored on this scale after their condition has been stabilized and they have been transferred to intensive care.  The lowest possible score is 3 and the highest, 15. The higher the score, the better.

Best eye response

No score is given if the patient's injury makes it impossible to open the eyes, for example, swelling around the eyes can keep them closed.

Points Criteria
1 No eye opening.
2 Eye opening to pain.
3 Eye opening to verbal command.
4 Eyes open spontaneously.  For this score the patient need not demonstrate awareness of what he sees, he simply needs to open his eyes.

Best verbal response

Points Criteria
1 No verbal response.
2 Incomprehensible sounds, such as moaning, groaning and grunting.
3 Intelligible but inappropriate words, such as swearing, shouting. Does not carry on a meaningful exchange.
4 Confused.  Responds to questions but the answers are confused or disoriented.
5 Responds appropriately to questions. Converses. Demonstrates awareness of the time, the location and persons. 

Best motor response

The examining physician stimulates the patient by mild pressure on the nail bed, and supraorbital pressure.

Points Criteria
1 No motor response.
2 Moves arm at elbow.
3 Flexion to pain.
4 Withdrawal from pain.
5 Localizes the stimulus and attempts to remove it.  For example, in response to pressure on the eye, the patient raises his hand at least as far as the chin.  
6 Obeys commands.

The score is best recorded in the form E3V3M5 = GCS 11, because, for example, a patient with a tube in his throat can't make a verbal response, and a simple total would be misleading.  Sometimes in such cases the score is given as E3 Vintubated M6. Nevertheless, the total is a strong predictor of outcome:

1. G. Teasdale, B. Jennett.
Assessment of coma and impaired consciousness. A practical scale.
Lancet, 2 issue 7872, pages 81-84 (13 July 1974).

Further Reading

G. L. Sternbach.
The Glasgow coma scale.
Journal of Emergency Medicine, vol. 19, no. 1, pages 67-71 (July 2000).

G. M. Teasdale and L. Murray.
Revisiting the Glasgow Coma Scale and Coma Score.
Intensive Care Med vol. 26, no. 2, pages 153-154 (Feb. 2000).

Carole Rush interviewing Bryan Jennett.
The history of the Glasgow Coma Scale: an interview with professor Bryan Jennett.
International Journal of Trauma Nursing, vol. 3, no. 4, pages 114-118 (Oct-Dec 1997).

G. Teasdale, B. Jennett, L. Murray and G. Murray.
Glasgow coma scale: to sum or not to sum.
Lancet, issue 8351, page 678 (17 Sept 1983).

G. Teasdale, G. Murray, L. Parker and B. Jennett.
Adding up the Glasgow Coma Scale.
Acta Neurochir Suppl (Wien) vol. 28, no. 1, pages 13-16 (1979).

 

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