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 that 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 non-expert person to a sick or injured person 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, 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 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 disciplines underlying 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 university in the English-speaking world and one of Scotland's four ancient universities. Located in 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.
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 coordinates 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. It contains the majority of the nervous system and consists of the brain and the spinal cord, as well as. 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 external 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
The scale comprises three tests: eye Visual perception is the ability to interpret information and surroundings from the effects of 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, 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 sustain a living organism. The word refers both to the particular processes of life's cessation as well as to the condition or state of a formerly-living body), while the highest is 15 (fully awake person).
Best eye response (E)
There are 4 grades starting with the most severe:
- No eye opening
- Eye opening in response to pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone". (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 instances, 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.)
- Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
- Eyes opening spontaneously
Best verbal response (V)
There are 5 grades starting with the most severe:
- No verbal response
- Incomprehensible sounds. (Moaning but no words.)
- Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
- Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
- 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:
- No motor response
- 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)
- Abnormal flexion to pain (adduction Adduction is a movement which brings a part of the anatomy 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. In competitive sport competition, the Fencing Response is forearm)
- 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)
- 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 flat 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.)
- 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:
- Severe, with GCS ≤ 8
- Moderate, GCS 9 - 12
- Minor, GCS ≥ 13.
Intubation Tracheal intubation is the placement of a flexible plastic catheter into the trachea. This invasive medical procedure is frequently performed in critically injured, ill or anesthetized patients in order to facilitate positive pressure ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of pulmonary aspiration 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'. Often the 1 is left out, so the scale reads Ec or Vt.
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 Pediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.
Revisions
- Glasgow Coma Scale: While the 15 point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14 point scale, omitting the category of 'abnormal flexion'. Some centres still use this older scale, but most (including the Glasgow unit where the original work was done) have adopted the modified one.
- The Rappaport Coma/Near Coma Scale made other changes.
See also
- Blantyre Coma Scale The Blantyre Coma Scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children
- 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
- 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
- Revised Trauma Score The Revised Trauma Score is a tool for on-site triage for Multiple Casualty Incidents. Its superior efficiency is due to both speed and objectivity. It is designed to provide a comprehensive assessment for medical professionals of any field
References
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals. The Lancet was founded in 1823 by Thomas Wakley, an English surgeon who named it after the surgical instrument called a lancet, as well as after the term "lancet arch", a window with a 1974,2:81-84. PMID 4136544.
External links
- Website to calculate the Glasgow Coma Scale
- MeSH Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching. Created and updated by the United States National Library of Medicine (NLM), it is used by the MEDLINE/PubMed article database and by NLM's Glasgow+Coma+Scale
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
|
Wed, 21 Jul 2010 17:39:09 GMT+00:00
Journal of Bone and Joint Surgery (subscription) Demographic characteristics, Glasgow Coma Scale scores, evidence of previous neurological disorder, and the results of the OT HIMS (Occupational Therapy ...
Dr Arun Pal Singh
Sun, 06 Jan 2008 03:26:03 GM
The . Glasgow Coma Scale. has limited applicability to children, especially below the age of 36 months because then verbal performance of even a healthy child could be labeled to be poor). To avoid this Paediatric . Glasgow Coma Scale. , ...
