Glasgow Coma Scale (GCS) Assesment

The Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. For adults the scores are as follows:
Tabel I :
Eye Opening Response (E) 4=Spontaneous
3=To voice
2=To pain
1=None 5=Normal conversation

Verbal Response (V) 4=Disoriented conversation
3=Words, but not coherent
2=No words......only sounds
1=None

Motor Response (M) 6=Normal
5=Localizes to pain
4=Withdraws to pain
3=Decorticate posture
2=Decerebrate
1=None

Total E+V+M= ?

The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury.
It is used primarily because it is simple, has a relatively high degree of interobserver reliability and because it correlates well with outcome following severe brain injury.
It is easy to use, particularly if a form is used with a table similar to the one above. One determines the best eye opening response, the best verbal response, and the best motor response.
The score represents the sum of the numeric scores of each of the categories. There are limitations to its use. If the patient has an endotracheal tube in place, they cannot talk.
For this reason, many prefer to document the score by its individual components; so a patient with a Glasgow Coma Score of 15 would be documented as follows: E4 V5 M6. An intubated patient would be scored as E4 Vintubated M6. Of these individual factors, the best motor response is probably the most significant.
Other factors which alter the patients level of consciousness interfere with the scale's ability to acurately reflect the severity of a traumatic brain injury. So, shock, hypoxemia, drug use, alcohol intoxication, metabolic disturbances may alter the GCS independently of the brain injury.
Obviously, a patient with a spinal cord injury will make the motor scale invalid, and severe orbital trauma may make eye opening impossible to assess.
The GCS also has limited utility in children, particularly those less than 36 months. In spite of these limitations, it is quite useful and is far and away the most widely used scoring system used today to assess patients with traumatic brain injury.



II :
Eye Opening Response Spontaneous--open with blinking at baseline 4 points
Opens to verbal command, speech, or shout 3 points
Opens to pain, not applied to face 2 points
None 1 point
Verbal Response Oriented 5 points
Confused conversation, but able to answer questions 4 points
Inappropriate responses, words discernible 3 points
Incomprehensible speech 2 points
None 1 point
Motor Response Obeys commands for movement 6 points
Purposeful movement to painful stimulus 5 points
Withdraws from pain 4 points
Abnormal (spastic) flexion, decorticate posture 3 points
Extensor (rigid) response, decerebrate posture 2 points
None 1 point


For children under 5, the verbal response criteria are adjusted as follow :
SCORE 2 to 5 YRS 0 TO 23 Mos.
5 Appropriate words or phrases Smiles or coos appropriately
4 Inappropriate words Cries and consolable
3 Persistent cries and/or screams Persistent inappropriate crying &/or screaming
2 Grunts Grunts or is agitated or restless
1 No response No response