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Glasgow Coma Scale or GCS, is a neurologicalscale which 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, EMS and doctors as being applicable to all acute

medical and trauma patients. In hospitals it is also used in monitoring chronic

patients in intensive care.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett,

professors of neurosurgery at the University of Glasgow. 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, including APACHE II, SAPS II,

and SOFA, to assess the status of the central nervous system. A similar scale,

the Rancho Los Amigos Scale is used to assess the recovery oftraumatic brain

injury patients.

Glasgow Coma Scale

1 2 3 4 5 6

EyesDoes not

open eyes

Opens eyes inresponse to

painful stimuli

Opens eyesin response

to voice

Opens eyesspontaneously

N/A N/A

Verbal

Makes nosounds

Incomprehensible sounds

Uttersinappropriate

words

Confused,disoriented

Oriented,conversesnormally

N/A

Motor

Makes nomovement

Extension to Abnormalflexion to

Flexion /Withdrawal to

Localizespainful

Obeyscommand
http://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Scale_(ratio)http://en.wikipedia.org/wiki/Level_of_consciousnesshttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/First_aidhttp://en.wikipedia.org/wiki/Emergency_medical_serviceshttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Bryan_J._Jennetthttp://en.wikipedia.org/wiki/University_of_Glasgowhttp://en.wikipedia.org/wiki/Special:BookSources/0803650191http://en.wikipedia.org/wiki/ICU_scoring_systemshttp://en.wikipedia.org/wiki/APACHE_IIhttp://en.wikipedia.org/wiki/SAPS_IIhttp://en.wikipedia.org/wiki/SOFA_Scorehttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Rancho_Los_Amigos_Scalehttp://en.wikipedia.org/wiki/Traumatic_brain_injuryhttp://en.wikipedia.org/wiki/Traumatic_brain_injuryhttp://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Scale_(ratio)http://en.wikipedia.org/wiki/Level_of_consciousnesshttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/First_aidhttp://en.wikipedia.org/wiki/Emergency_medical_serviceshttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Bryan_J._Jennetthttp://en.wikipedia.org/wiki/University_of_Glasgowhttp://en.wikipedia.org/wiki/Special:BookSources/0803650191http://en.wikipedia.org/wiki/ICU_scoring_systemshttp://en.wikipedia.org/wiki/APACHE_IIhttp://en.wikipedia.org/wiki/SAPS_IIhttp://en.wikipedia.org/wiki/SOFA_Scorehttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Rancho_Los_Amigos_Scalehttp://en.wikipedia.org/wiki/Traumatic_brain_injuryhttp://en.wikipedia.org/wiki/Traumatic_brain_injury

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s painful stimulipainfulstimuli

painful stimuli stimuli s

The scale comprises 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 ordeath), while the highest is 15 (fully awake person).

Best eye response (E)

There are 4 grades starting with the most severe:

1. No eye opening

2. Eye opening in response to pain. (Patient responds to pressure on the

patients fingernail bed; if this does not elicit a

response, supraorbital and sternal pressure or rub may be used.)

3. Eye opening to speech. (Not to be confused with an awaking of a

sleeping person; such patients receive a score of 4, not 3.)

4. Eyes opening spontaneously

Best verbal response (V)


1. No verbal response

2. Incomprehensible sounds. (Moaning but no words.)

3. Inappropriate words. (Random or exclamatory articulated speech, but

no conversational exchange)

4. Confused. (The patient responds to questions coherently but there is

some disorientation and confusion.)

5. Oriented. (Patient responds coherently and appropriately to questions

such as the patients name and age, where they are and why, the year,

month, etc.)

Best motor response (M)


1. No motor response
http://en.wikipedia.org/wiki/Visual_perceptionhttp://en.wikipedia.org/wiki/Speech_communicationhttp://en.wikipedia.org/wiki/Motor_skillhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Deathhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Fingernail_bedhttp://en.wikipedia.org/wiki/Supraorbital_ridgehttp://en.wikipedia.org/wiki/Sternumhttp://en.wikipedia.org/wiki/Visual_perceptionhttp://en.wikipedia.org/wiki/Speech_communicationhttp://en.wikipedia.org/wiki/Motor_skillhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Deathhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Fingernail_bedhttp://en.wikipedia.org/wiki/Supraorbital_ridgehttp://en.wikipedia.org/wiki/Sternum

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2. Extension to pain (abduction of arm, internal rotation of

shoulder, pronation of forearm, extension of wrist, decerebrate response)

3. Abnormal flexion to pain (adduction of arm, internal rotation of

shoulder, pronation of forearm, flexion of wrist, decorticate response)

4. 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)

5. Localizes to pain. (Purposeful movements towards painful stimuli; e.g.,

hand crosses mid-line and gets above clavicle when supra-orbital pressure

applied.)

6. 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

Moderate, GCS 9 - 12

Minor, GCS 13.

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 thePaediatric Glasgow Coma Scale, a separate yet closely

related scale, was developed for assessing younger children.
http://en.wikipedia.org/wiki/Abduction_(kinesiology)http://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Extension_(kinesiology)http://en.wikipedia.org/wiki/Decerebrate_responsehttp://en.wikipedia.org/wiki/Adductionhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Decorticate_responsehttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Claviclehttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Paediatric_Glasgow_Coma_Scalehttp://en.wikipedia.org/wiki/Abduction_(kinesiology)http://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Extension_(kinesiology)http://en.wikipedia.org/wiki/Decerebrate_responsehttp://en.wikipedia.org/wiki/Adductionhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Decorticate_responsehttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Claviclehttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Paediatric_Glasgow_Coma_Scale

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