Glasgow Coma Scale

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Jump to: navigation, search The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. patient is assessed against the criteria of the scale, and the resulting points give a patient score between ! "indicating deep unconsciousness# and either $% "original scale# or $& "the more widely used modified or revised scale#. '() was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, *+) and doctors as being applicable to all acute medical and trauma patients. ,n hospital it is also used in chronic patient monitoring, in for instance, intensive care. The scale was published in $-.% by 'raham Teasdale and /ryan J. Jennett, professors of neurosurgery at the 0niversity of 'lasgow. The pair went on to author the te1tbook Management of Head Injuries "F 2avis $-3$, ,)/4 5635!76&5$-6$#, a celebrated work in the field. '() is used as part of several ,(0 scoring systems, including 8 (9* ,,, ) 8) ,,, and ):F , to assess the status of the central nervous system. similar scale, the ;ancho <os migos )cale is used to assess the recovery of traumatic brain injury patients.

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$ *lements of the scale o $.$ /est eye response "*# o $.? /est verbal response "@# o $.! /est motor response "+# ? ,nterpretation ! ;evisions % )ee also & ;eferences 7 *1ternal links

[edit] Elements of the scale

Glasgow Coma Scale

Eyes

2oes not open eyes

:pens eyes in :pens eyes :pens eyes response to in response to spontaneously painful stimuli voice

4A

4A

0tters +akes no ,ncomprehensible Ver al inappropriate sounds sounds words

(onfused, disoriented

:riented, converses normally

4A

!otor

+akes no movements

*1tension to painful stimuli

bnormal Fle1ion A <ocaliBes fle1ion to :beys Withdrawal to painful painful (ommands painful stimuli stimuli stimuli

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible '() "the sum# is ! "deep coma or death#, whilst the highest is $& "fully awake person#. [edit] "est eye res#onse $E% There are % grades starting with the most severe: $. 4o eye opening ?. *ye opening in response to pain. "8atient responds to pressure on the patientCs fingernail bedD if this does not elicit a response, supraorbital and sternal pressure or rub may be used.# !. *ye opening to speech. "4ot to be confused with an awaking of a sleeping personD such patients receive a score of %, not !.# %. *yes opening spontaneously [edit] "est &er al res#onse $V% There are & grades starting with the most severe: $. 4o verbal response ?. ,ncomprehensible sounds. "+oaning but no words.#

!. ,nappropriate words. ";andom or e1clamatory articulated speech, but no conversational e1change# %. (onfused. "The patient responds to Euestions coherently but there is some disorientation and confusion.# &. :riented. "8atient responds coherently and appropriately to Euestions such as the patientCs name and age, where they are and why, the year, month, etc.# [edit] "est motor res#onse $!% There are 7 grades starting with the most severe: $. 4o motor response ?. *1tension to pain "adduction of arm, internal rotation of shoulder, pronation of forearm, e1tension of wrist, decerebrate response# !. bnormal fle1ion to pain "adduction of arm, internal rotation of shoulder, pronation of forearm, fle1ion of wrist, decorticate response# %. Fle1ionAWithdrawal to pain "fle1ion of elbow, supination of forearm, fle1ion of wrist when supra6orbital pressure applied D pulls part of body away when nailbed pinched# &. <ocaliBes to pain. "8urposeful movements towards painful stimuliD e.g., hand crosses mid6line and gets above clavicle when supra6orbital pressure applied.# 7. :beys commands. "The patient does simple things as asked.#

[edit] 'nter#retation
,ndividual elements as well as the sum of the score are important. 9ence, the score is e1pressed in the form F'() - G *? @% +! at 5.:!&F. 'enerally, comas are classified as:

)evere, with '() H 3 +oderate, '() - 6 $? +inor, '() I $!.

,ntubation and severe facialAeye swelling or damage, make it impossible to test the verbal and eye responses. ,n these circumstances, the score is given as $ with a modifier attached e.g. J*$cJ where JcJ G closed, or J@$tJ where t G tube. composite might be J'() &tcJ. This would mean, for e1ample, eyes closed because of swelling G $, intubated G $, leaving a motor score of ! for Jabnormal fle1ionJ. The '() has limited applicability to children, especially below the age of !7 months "where the verbal performance of even a healthy child would be e1pected to be poor#. (onseEuently the 8aediatric 'lasgow (oma )cale, a separate yet closely related scale, was developed for assessing younger children.

[edit] (e&isions

'lasgow (oma )cale: While the $& point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the +odified 'lasgow (oma )cale. The original scale was a $% point scale, omitting the category of Jabnormal fle1ionJ. )ome centres still use this older scale, but most "including the 'lasgow unit where the original work was done# have adopted the modified one. The ;appaport (omaA4ear (oma )cale made other changes.

[edit] See also

/lantyre (oma )cale ;ancho <os migos )cale 8ediatric 'lasgow (oma )cale ;evised Trauma )core

[edit] (eferences

Teasdale ', Jennett /. Assessment of coma and impaired consciousness. A practical scale. <ancet $-.%,?:3$63%. 8+,2 %$!7&%%.

[edit] E)ternal lin*s

Website to calculate the 'lasgow (oma )cale +e)9 Glasgow+Coma+Scale

;etrieved from Fhttp:AAen.wikipedia.orgAwikiA'lasgowK(omaK)caleF