The Glasgow Coma Score

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Introduction

The Glasgow Coma Scale was first published in 1974 at the University of Glasgow by neurosurgery professors Graham Teasdale and Bryan Jennett.  The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses. Reporting each of these separately provides a clear, communicable picture of a patient’s state.

The findings in each component of the scale can aggregate into a total Glasgow Coma Score which gives a less detailed description but can provide a useful ‘shorthand’ summary of the overall severity.  The score expression is the sum of the scores as well as the individual elements. For example, a score of 10 might be expressed as GCS10 = E3V4M3.

The use of the Glasgow Coma Scale became widespread in the 1980s when the first edition of the Advanced Trauma and Life Support recommended its use in all trauma patients. Additionally, the World Federation of Neurosurgical Societies (WFNS) used it in its scale for grading patients with subarachnoid hemorrhage in 1988, The Glasgow Coma Scale and its total score have since been incorporated in numerous clinical guidelines and scoring systems for victims of trauma or critical illness.  

Function

Scoring and Parameters

The Glasgow Coma Scale divides into three parameters: best eye response (E), best verbal response (V) and best motor response (M). The levels of response in the components of the Glasgow Coma Scale are ‘scored’ from 1, for no response, up to normal values of 4 (Eye-opening response) 5 ( Verbal response) and 6 (Motor response)

The total Coma Score thus has values between three and 15, three being the worst and 15 being the highest. 

The score is the sum of the scores as well as the individual elements. For example, a score of 10 might be expressed as GCS10 = E3V4M3.

Best eye response (4)

  1. No eye opening
  2. Eye opening to pain
  3. Eye opening to sound
  4. Eyes open spontaneously

Best verbal response (5)

  1. No verbal response
  2. Incomprehensible sounds
  3. Inappropriate words
  4. Confused
  5. Orientated

Best motor response (6)

  1. No motor response.
  2. Abnormal extension to pain 
  3. Abnormal flexion to pain 
  4. Withdrawal from pain
  5. Localizing pain
  6. Obeys commands
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