Glasgow Coma Scale (GCS)

Background

The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a patient's level of consciousness after a brain injury, Glasgow Coma Scale (GCS) was first introduced in 1974 by Bryan Jennett and Graham Teasdale to assess coma and impaired consciousness in patients who have suffered head injury or other acute brain damage.

The GCS is used in clinics worldwide by physicians, nurses, and emergency medical technicians; it is also applied widely as a component of many, more complex systems that are used in assessing acute brain damage, such as the Revised Trauma Score, Trauma and Injury Severity Score, and World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Scale.

The scale is used to describe variations in three clinical features: the patient's eye, motor, and verbal responses. The authors assigned numerical scores to each feature depending on the quality of the response. GCS sum scores (including eye + motor + verbal responses) range from 3 (deep coma) to 15 (full consciousness).

The GCS assesses a patient based on their ability to perform eye movements, speak, and move their body. These three behaviors make up the three elements of the scale: eye, verbal, and motor.

A patient's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalized patients and track their level of consciousness.

Lower GCS scores are correlated with higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual patient with brain injury. 

The Glasgow Coma Scale is used for people above the age of two and composed of three tests: eye, verbal, and motor responses

Eye Opening (E)

    4 = spontaneous
    3 = to sound
    2 = to pressure
    1 = none
    NT = not testable

Verbal Response (V)

    5 = orientated
    4 = confused
    3 = words, but not coherent
    2 = sounds, but no words
    1 = none
    NT = not testable

Motor Response (M)

    6 = obeys command
    5 = localizing
    4 = normal flexion
    3 = abnormal flexion
    2 = extension
    1 = none
    NT = not testable

Pediatric Glasgow Coma Scale

Children below the age of two struggle with the tests necessary for assessment of the Glasgow Coma Scale. As a result, a version for children has been developed, and is outlined below. 

The GCS is usually not used with children, especially those too young to have reliable language skills. The Pediatric Glasgow Coma Scale(PGCS), a modification of the scale used on adults, is used instead.