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GCS - Glasgow Coma Scale

Vijayarani Sivakumar

Published On - February 07, 2024

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. 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 summary of the overall severity. 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. This activity describes the use of the Glasgow Coma Scale and reviews the role of using the scale for the interprofessional team to successfully communicate a patients condition.

Objectives:

• Explain the value of the Glasgow Coma Scale for patient care.
• Outline the three areas the Glascow Coma Scales assesses.
• Summarize the severity findings for each range of the Glascow Coma Scale.
• Review how the interprofessional team can use the Glasgow Coma Scale to communicate regarding a patients condition.

Introduction

The Glasgow Coma Scale was first published in 1974 at the University of Glasgow by neurosurgery professors Graham Teasdale and Bryan Jennet 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.

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

Issues of Concern

The following factors may interfere with the Glasgow Coma Scale assessment:

1. Pre-existing factors
• Language barriers
• Intellectual or neurological deficit
• Hearing loss or speech impediment
2. Effects of current treatment
• Physical (e.g., intubation): If a patient is intubated and unable to speak, they are evaluated only on the motor and eye-opening response and the suffix T is added to their score to indicate intubation.
• Pharmacological (e.g., sedation) or paralysis: If possible, the clinician should obtain the score before sedating the patient.
3. Effects of other injuries or lesions
• Orbital/cranial fracture
• Spinal cord damage
• Hypoxic-ischemic encephalopathy after cold exposure