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The Glasgow Coma Scale (GCS) is used to describe the level of consciousness in an individual.
It is often used to gauge the severity of an acute brain injury due to trauma or medical cause. The test is simple, reliable, and correlates well with outcomes following brain injury. It is composed of 3 domains which are assessed separately and given numerical scores. The sum of these scores is the Glasgow Coma Score.
The three areas are
Eye Opening,
Verbal Response, and
Motor Activity.
EYE-OPENING (1-4 Points)
1. Does not open eyes in response to anything.
2. Opens eyes in response to painful stimuli.
3. Opens eyes in response to voice.
4. Opens eyes spontaneously.
VERBAL RESPONSE (1-5 Points)
1. Makes no sounds.
2. Incomprehensible sounds.
3. Utters incoherent words.
4. Confused, disoriented.
5. Oriented, converses normally.
MOTOR ACTIVITY (1-6 Points)
1. Makes no movements.
2. Decerebrate (extensor) posture (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backward).
3. Decorticate (flexor) posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest).
4. Withdrawal from painful stimuli.
5. Localizes to painful stimuli.
6. Obeys commands.
EXAMPLE: So a patient who has scores of Eye = 3, Verbal = 4 and Motor = 5 is said to have a GCS of 12.
You would express this as a GCS 12 = E3, V4, M5.
There are some GCS scores that are significant and must be memorized:
· 3: The lowest possible GCS; this indicates a patient is wholly unresponsive.
· 8: The point of intubation; any patient with an 8 or lower is strongly considered for intubation, as they are unlikely to maintain a patent airway.
· 15: The highest GCS score; a patient who opens their eyes spontaneously, is oriented and alert, and obeys commands has a GCS of 15.
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