The Glasgow Coma Score (or GCS) is a neurological scale used
in many settings to objectively classify the level of consciousness
of patients. It was initially developed for head-injured patients, but
its use has been extrapolated to chronically critically ill patients,
and it is one component of several different intensive care severity
scoring systems (Figure 11-1).
- ▪ Eye response: Eye opening in response to various levels
- ▪ Verbal response: Verbal communication in terms of comprehensibility
- ▪ Motor response: Movement in response to various stimuli
- ▪ Eye response (E)
- —No eye opening = 1
- —Eye opening in response to pain (ie, pressure on
fingernail bed, mandible, supraorbital area, or sternum) = 2
- —Eye opening to speech = 3
- —Spontaneous eye opening = 4
- ▪ Verbal response (V)
- —No verbal response = 1
- —Incomprehensible sounds (ie, moaning) = 2
- —Inappropriate words (ie, random sounds or speech) = 3
- —Confused, coherent speech (ie, disorientation or
confusion) = 4
- —Oriented = 5
- ▪ Motor (M)
- —No movements = 1
- —Extension in response to painful stimuli (ie, decerebrate
posturing) = 2
- —Flexion in response to pain (ie, decorticate posturing) = 3
- —Flexion withdrawal in response to pain (ie, withdrawal
of body part in response to stimulus) = 4
- —Localized movements in response to pain (ie, purposeful
movements across midline toward painful stimulus) = 5
- —Obeys commands = 6
- ▪ GCS less than or equal to 8 is consistent with severe
brain injury when applied to head injured population.
- ▪ GCS 9 to 12 consistent with moderate brain injury.
- ▪ GCS greater than or equal to 13 consistent with minor injury.
- ▪ Modifiers are used in the presence of severe eye/facial
swelling, spinal cord injury, or oral intubation to indicate that
that portion of the exam cannot be performed (ie, 11T indicates
a normal eye and motor exam in an intubated patient).
Clinical Pearls and Pitfalls
- ▪ Some examiners
break the score down by individual components (ie, E4V5M6) to precisely specify
the components of the exam.
- ▪ A variety
of independent factors may interfere with the applicability of the
GCS to traumatic brain injury because they act as confounders, such
as intoxication, sepsis, and shock.
- ▪ Alternative
scores have been developed for use in children of various ages.
- ▪ The GCS has
been used successfully to predict outcome in a variety of settings
Wijdicks EF. Clinical scales for comatose patients: the Glasgow
Coma Scale in historical context and the new FOUR score. Rev Neurol