Glasgow Coma Scale

What is the Glasgow Coma Scale (GCS)?

The Glasgow Coma Scale (GCS) is a widely used clinical scale that assesses the level of consciousness and neurological function in patients with acute brain injury or impaired consciousness. Developed by Sir Graham Teasdale and Bryan Jennett at the University of Glasgow in 1974, the GCS provides a structured approach to evaluating and communicating a patient's condition (Teasdale et al., 2014).

The Glasgow structured approach is widely used in various settings, including the emergency department, intensive care units, research in neurological sciences, and trauma centers. It is particularly useful in the initial assessment and management of trauma patients.

Components of the Glasgow Coma Scale

The Glasgow Coma Scale assessment process involves testing the eye-opening, verbal response, and motor responses. Each component is scored independently, and the sum of these scores determines the overall GCS score (Jain & Iverson, 2023).

• Eye-opening response: The eye-opening response is scored on a scale of 1 to 4, with 4 being the best eye-opening response (spontaneous eye-opening) and 1 being the worst (no eye-opening).
• Verbal response: The verbal score ranges from 1 to 5, with no verbal response (1) and oriented and conversing normally (5) being the best verbal response. It assesses the patient's ability to respond verbally to questions or commands.
• Motor response: This is scored on a scale of 1 to 6, with 6 being the best motor response (obeying commands) and 1 being the worst response (no motor response). It evaluates the patient's ability to follow verbal commands and move their extremities.

How to use this Glasgow Coma Scale template

Carepatron's Glasgow Coma Scale template is a great way to securely and accurately record your patient's GCS results. Here's a step-by-step guide on how to use this tool

Step 1: Introduce the test

Before administering the Glasgow Coma Scale, it's essential to introduce the test to the patient (if they are conscious) or their family members. Explain that the GCS is a standardized assessment tool used to evaluate the patient's level of consciousness and neurological function in case of a head injury. Reassure them that the process is noninvasive and will involve observing their responses to various stimuli.

Step 2: Assess eye-opening response

Begin by evaluating the patient's eye response. Observe if they open their eyes spontaneously (score 4), in response to verbal stimuli (score 3), in response to painful stimuli (score 2), or if they do not open their eyes at all (score 1).

Step 3: Evaluate verbal response

Next, assess the patient's verbal performance. Determine if they are oriented and conversing normally (score 5), confused or using inappropriate words (score 4), uttering incomprehensible sounds (score 3), making no verbal response (score 2), or completely unresponsive (score 1).

Step 4: Examine motor response

The motor scale evaluates the patient's motor response by observing their ability to follow commands. The motor score is 6 if they obey commands, 5 if they localize to painful stimuli, 4 if they withdraw from painful stimuli, 3 for abnormal flexion (decorticate posturing), 2 for abnormal extension (decerebrate posturing), and 1 for no motor response.

Step 5: Calculate the Glasgow Coma Scale score and interpret

Add the total score for eye-opening, verbal response, and motor response to obtain the total GCS score. The maximum GCS score is 15, indicating a fully awake and responsive patient, while the minimum score is 3, indicating a deeply comatose state. Remember that the GCS is a screening tool and should be used in conjunction with other clinical assessments and diagnostic tests.

Scoring and interpretation

When using the Glasgow Coma Scale, it's essential to understand how to score and interpret the results properly. The GCS provides a standardized and structured approach to assessing a patient's level of consciousness and neurological function, particularly in cases of traumatic brain injury or acute brain damage.

These individual components are scored independently on a scale, and the sum of these scores determines the overall Glasgow coma score.

The following scores are given for the eye-opening response:

• Score 4: Spontaneous eye opening
• Score 3: Eye opening in response to verbal stimuli
• Score 2: Eye opening in response to painful stimuli or pressure
• Score 1: No eye opening
• NT: Non-testable

For the verbal response, the following observations are to be noted:

• Score 5: Oriented and conversing normally
• Score 4: Confused
• Score 3: Uttering intelligible single words
• Score 2: Only moans and groans
• Score 1: No verbal response
• NT: Non-testable

The following scores are then given for motor response:

• Score 6: Obeying commands
• Score 5: Localizing to painful stimuli
• Score 4: Normal flexion
• Score 3: Abnormal flexion
• Score 2: Extension
• Score 1: None
• NT: Non-testable

The total coma score is the sum of the individual component scores, ranging from a maximum of 15 (fully awake and responsive) to a minimum of 3 (deeply comatose state). The GCS score is commonly interpreted as follows:

• 13-15: Mild brain injury
• 9-12: Moderate brain injury
• 3-8: Severe brain injury

It's important to note that the GCS is a screening tool and should be used in conjunction with other clinical assessments and diagnostic tests. It provides a reliable and consistent method for assessing and communicating a patient's level of consciousness and neurological function, aiding in triage, treatment decisions, and monitoring of their condition over time.

When should you use the Glasgow Coma Scale?

The Glasgow Coma Scale is a widely used and valuable tool for assessing the level of consciousness in various clinical scenarios. It provides a standardized method for evaluating the severity of brain injuries and guiding treatment decisions. The GCS is essential in the following situations:

Traumatic brain injury

In cases of mild traumatic brain injury, such as a concussion or moderate injury, the GCS helps determine the severity of the injury and guides appropriate management and monitoring.

The GCS is essential in the assessment and early management of moderate to severe traumatic brain injuries, which may result from events like a car accident, a fall, or in case of severe injuries. It aids in triaging patients, predicting outcomes, and guiding treatment decisions.

Acute brain damage

The GCS is recommended for evaluating patients with acute brain damage or impaired consciousness due to various causes, such as stroke, intracranial hemorrhage, blunt head trauma, or even severe brain damage. It helps assess the patient's consciousness level and neurological status, guiding further diagnostic tests and interventions.

Advanced trauma life support (ATLS)

In the context of advanced trauma life support, the GCS is a crucial component of the primary survey. It provides a structured approach to assessing the patient's level of consciousness and neurological function, which can inform the management of life-threatening injuries.

Intubated patients

The GCS can be used to assess the level of consciousness in intubated patients, particularly when verbal responses are impossible, such as from patients in deep coma. In such cases, alternative scoring methods like the GCS-P score (pupil reactivity) or the simplified motor score may be employed.

Special considerations

For assessing younger children, a modified version called the Pediatric Glasgow Coma Scale (PGCS) may be used, as it accounts for developmental differences in verbal and motor responses.

The Glasgow Coma Scale is a valuable tool that provides a standardized and structured approach to assessing the level of consciousness and neurological function in various clinical settings. It is recommended for the early management of head injuries and for monitoring and predicting outcomes in neurological conditions.

For streamlined health assessments and improved patient care management, explore our templates and related tools, including Case Notes Template, to maintain organized and accessible patient information.

References

Jain, S., & Iverson, L. M. (2023, June 12). Glasgow coma scale. National Library of Medicine; StatPearls Publishing. https://ncbi.nlm.nih.gov/books/NBK513298/

Teasdale, G., Maas, A., Lecky, F., Manley, G., Stocchetti, N., & Murray, G. (2014). The Glasgow coma scale at 40 years: Standing the test of time. The Lancet Neurology, 13(8), 844–854. https://doi.org/10.1016/s1474-4422(14)70120-6