Glasgow Coma Scale or GCS, is a neurological Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. The corresponding surgical specialty scale The scale ratio of some sort of model which represents an original proportionally is the ratio of a linear dimension of the model to the same dimension of the original. Examples include a 3-dimensional scale model of a building or the scale drawings of the elevations or plans of a building. In such cases the scale is dimensionless and exact 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 An altered level of consciousness is an measure of arousal other than normal. Level of consciousness is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousness may be classed as lethargy; someone in this state can be aroused with little difficulty. People who are after head injury Head injury refers to trauma to the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in the medical literature, and the scale is now used by first aid First aid is the provision of initial care for an illness or injury. It is usually performed by a lay person to a sick or injured casualty until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of, EMS Emergency medical services are a branch of emergency services dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency and doctors A physician — also known as medical practitioner, doctor of medicine, medical doctor, or simply doctor — practices the ancient profession of medicine, which is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease or injury. This properly requires both a detailed knowledge of the academic as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill and who usually require intensive monitoring.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett Bryan Jennett was a pioneering Professor of Neurosurgery who established Glasgow as a world centre in the speciality and made major advances in the care and management of patients. Under his leadership the city became a global centre for innovation in Neuroscience and attracted a generation of international collaborators and trainees to the extent, professors of neurosurgery at the University of Glasgow The University of Glasgow is the fourth-oldest surviving university in the English-speaking world and one of Scotland's four ancient universities. Located in the UK city of Glasgow, the university was founded in 1451 and is presently one of seventeen British higher education institutions ranked amongst the top 100 of the world. 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 Shock sequence: SIRS · Sepsis · Severe sepsis · Septic shock, including APACHE II APACHE II is a severity of disease classification system (Knaus et al., 1985), one of several ICU scoring systems. After admission of a patient to an intensive care unit, an integer score from 0 to 71 is computed based on several measurements; higher scores imply a more severe disease and a higher risk of death, SAPS II SAPS II is a severity of disease classification system . Its name stands for "Simplified Acute Physiology Score", and is one of several ICU scoring systems, and SOFA The Sequential Organ Failure Assessment score, or just SOFA score, is used to track a patient's status during the stay in an intensive care unit . It is one of several ICU scoring systems, to assess the status of the central nervous system The central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish. In vertebrates, the central nervous system is enclosed in the meninges. It contains the. A similar scale, the Rancho Los Amigos Scale The Rancho Los Amigos Scale is a medical scale intended to assess the level of recovery of brain injury patients and those recovering from coma. It is named after the Rancho Los Amigos National Rehabilitation Center is used to assess the recovery of traumatic brain injury Traumatic brain injury occurs when an outside force traumatically injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g. occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage patients.

Contents

Elements of the scale

Glasgow Coma Scale
1 2 3 4 5 6
Eyes Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A
Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
Motor Makes no movements Extension to painful stimuli Abnormal flexion to painful stimuli Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands

The scale comprises three tests: eye Visual perception is the ability to interpret information and surroundings from visible light reaching the eye. The resulting perception is also known as eyesight, sight or vision. The various physiological components involved in vision are referred to collectively as the visual system, and are the focus of much research in psychology, cognitive, verbal Speech is the vocalized form of human communication. It is based upon the syntactic combination of lexicals and names that are drawn from very large vocabularies. Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units. These vocabularies, the syntax which structures them, and their and motor Motor skill dysfunction has many causes, e.g. demyelination of motor neurons. While fatigue or weariness may lead to temporary short-term deterioration of fine motor skills , serious nervous disorders may result in a loss of both gross and fine motor skills due to the hampering of muscular control. A defect in muscle is also a symptom of motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma In medicine, a coma is a profound state of unconsciousness. A person in a coma cannot be awakened, fails to respond normally to pain, light or sound, does not have sleep-wake cycles, and does not take voluntary actions. A person in a state of coma can be described as comatose or death Death is the termination of the biological functions that define a living organism. It refers both to a particular event and to the condition that results thereby. The true nature of the latter has, for millennia, been a central concern of the world's religious traditions and of philosophical enquiry. Belief in some kind of afterlife or rebirth is), 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 Pain is the unpleasant and aversive feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut and bumping the "funny bone". The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or. (Patient responds to pressure on the patient’s fingernail bed A nail is a horn-like structure at the end of an animal's finger or toe. See also claw; if this does not elicit a response, supraorbital The supraorbital ridge, or brow ridge, refer to a bony ridge located above the eye sockets of all primates. In Homo sapiens sapiens the eyebrows are located on their lower margin and sternal The sternum is a long flat bone (or, in some models, set of three bones) shaped like a capital 'T' located in the center of the thorax (chest). It connects to the rib bones via cartilage, forming the anterior section of the rib cage with them, and thus helps to protect the lungs, heart and major blood vessels from physical trauma 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)

There are 5 grades starting with the most severe:

  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 patient’s name and age, where they are and why, the year, month, etc.)

Best motor response (M)

There are 6 grades starting with the most severe:

  1. No motor response
  2. Extension to pain (abduction Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction of arm, internal rotation of shoulder, pronation In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a posterior-facing position without an associated movement at of forearm, extension Extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of the arm would require extension at the elbow joint. If the head is of wrist, decerebrate response Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract. In competitive sport competition, the Fencing Response is forearm)
  3. Abnormal flexion to pain (adduction Adduction is a movement which brings a limb — arm or leg — closer to the sagittal plane of the body. It is opposed to abduction of arm, internal rotation of shoulder, pronation In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a posterior-facing position without an associated movement at of forearm, flexion In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular (muscles and tendons) systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder. The trunk may be flexed toward the legs or the neck to of wrist, decorticate response Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract. The posturing may also occur without a stimulus. Since posturing)
  4. Flexion/Withdrawal to pain (flexion In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular (muscles and tendons) systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder. The trunk may be flexed toward the legs or the neck to of elbow, supination Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet of forearm, flexion In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular (muscles and tendons) systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder. The trunk may be flexed toward the legs or the neck to 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 In human anatomy, the clavicle or collar bone is classified as a long bone that makes up part of the shoulder girdle . It receives its name from the Latin clavicula ("little key") because the bone rotates along its axis like a key when the shoulder is abducted. This movement is palpable. In some people, particularly females who may have 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:

Intubation In medicine, intubation refers to the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopic procedures, it is most often used to denote tracheal intubation. Tracheal intubation is the placement of a flexible plastic tube into the trachea to protect the patient's airway and provide a means 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 the Paediatric Glasgow Coma Scale The Paediatric Glasgow Coma Scale (also known as Pediatric Glasgow Coma Score (AmE) or simply PGCS) is the equivalent of the Glasgow Coma Scale (GCS) used to assess the mental state of adult patients. As many of the assessments for an adult patient would not be appropriate for infants, the scale was modified slightly. As with the GCS, the PGCS, a separate yet closely related scale, was developed for assessing younger children.

Revisions

See also

References

External links

Categories: Emergency medicine | Intensive care medicine Intensive care medicine is the subfield of medicine that treats patients in intensive care setting | Neuropsychological tests | Medical scales | Memory tests

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