Glasgow coma scale

From Ganfyd

Glasgow coma scale (GCS) was designed by the Glasgow neurosurgeons Teasdale and Jennett^[1] to deal with patients predominately with head injuries. It has stood the test of time as a consistent and reproducible and ubiquitous method of assessing consciousness.

The scale is used to calculate the total score. This is a subtle, but important difference. When communicating with other health professionals, it is preferable to give the scores for the individual components and to describe what the patient can or cannot do (rather than the total).

The GCS is a score out of 15, where 15 is the normal mental state. The scores are nice but in communication most clinicians prefer to talk in actual terms of what the patient can and cannot do; the gradation provided is priceless in economy of conveying clinical information. Absolute scores are useful but the real value in the score was in the days before CT imaging was readily available.

GCS

Eyes (E)

Please remember that ABC always comes before assessing GCS. A score of 8 or less indicates coma. The patient may not be able to protect their own airway and intubation should be considered.

4. Open spontaneously
3. Open to verbal command
2. Open to pain
1. No eye opening

This effectively tests 'AVPU' (alert, verbal, pain, unresponsive)

Verbal (V)

5. Orientated
4. Confused
3. Inappropriate words / phrases
2. Incomprehensible sounds
1. No response

Motor (M)

6. Obeys commands
5. Localises to pain
4. Withdrawal from pain
3. Abnormal flexion to pain
2. Extension to pain
1. No response

Use of the GCS is expected in national guidelines for head injury

Limitations

Although widely accepted and easy to perform, it may not give much more information than the AVPU scale. Another limitation is that the score can be misleading out of the clinical context. For instance, a clinically well patient with a score of 14 (e.g. patient with migraine) would be in a much better condition than a clinically unwell patient with a score of 15 (e.g. drowsy, eyes barely open)

Special Circumstances

Children

Child's Glasgow coma scale

Other injuries

Take into account, e.g. injured arm

References