Glasgow Coma Scale (GCS)

Glasgow Coma Scale (GCS)

Definition

A Glasgow Coma Scale (GCS) is the most widely used scoring system that determines the level of consciousness of an individual with a suspected or confirmed brain injury. Use of the GCS scale does not take place an in-depth neurologic assessment

Purpose

This scale is used to:

  1. Address the three areas of neurologic functioning
  2. Gives an overview of the patient’s level of consciousness (LOC)
  3. Evaluates the neurologic status of patients who have had a head or brain injury

This scale is not only used after a traumatic head or brain injury but is also utilized in first aid, Emergency medical services (EMS), acute cases and for the monitoring of chronic patients in intensive care units.

What is assessed or measured in GCS?

Use of the Glasgow Coma Scale does not take place an in-depth neurologic assessment rather it provides an evaluation of the patient’s responses in the following areas:

  1. Eye-opening responses
  2. Motor responses
  3. Verbal responses

The three areas are further divided into different levels where a number is assigned to each of the possible responses within the categories. A high number means that the response is normal while a low one denotes impairment of neurologic function. The calculated total figure indicates the severity of the coma a patient is experiencing.

The lowest score is 3 (least responsive) suggests or reflects that a patient is in a deep coma, while the highest score of 15 (most responsive) means that the patient is fully intact.

The Glasgow Coma Scale

Characteristic

Response

Score

Eye Opening(E) Spontaneous 4
To verbal command or speech 3
To pain 2
Does not open eyes to painful stimuli or no response 1
Best Motor Response (M) Obeys commands 6
Localizes pain; pushes stimuli away 5
Flexes and withdraws 4
Abnormal flexion (decorticate response) 3
Abnormal extension response (decerebrate response) 2
No motor response 1
Best Verbal Response (V)

(arouse patient with painful stimuli if necessary)

Oriented and converses 5
Disoriented and converses (confused conversation) 4
Uses inappropriate words 3
Makes incomprehensible sounds 2
No verbal response 1
Total: E + M + V 3 to 15

Interpretation of Scores

Individual categories or elements as wells as the sum of the score are important. The score is expressed in this form for a client who is most responsive:

“GCS 15 = E4 V5 M6 at 14:00”

This means that the client’s GCS total score is 15 where the Eye Opening is scored 4, Motor response of 6 and verbal response of 5 as of 2:00 in the afternoon or 14:00 in a 24-hour time format.

Coma is suspected if the GCS score is equal to or less than 7. A score equal to 8 or less could also suggest a severe brain injury. GCS 9-12 indicates moderate brain injury and more than 13 denotes minor brain injury. Coma with the use of GCS is defined as not opening the eyes, not obeying commands and no verbal response.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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