Evaluation of a patient's consciousness and its evolution over time
- Score from 3 to 15
- Under 8: coma
- Between 12 and 8: critical, case-by-case evaluation
- Pediatric patients (adapted scale)
- Deaf patients
- Patients with paralysis
Glasgow Coma Scale
|Eyes||Does not open eyes||Opens eyes in response to painful stimuli||Open eyes in response to voice||Opens eyes spontaneously|
|Verbal||Makes no sounds||Incomprehensible sounds||Utters inappropriate words||Confused, disoriented||Oriented converses normally|
|Motor||Makes no movements||Extension to painful stimuli (decerebrate response)||Abnormal flexion to painful stimuli (decorticate response)||Flexion/ withdrawal to painful stimuli||Localizes painful stimuli||Obeys commands|
Glasgow Scale for Pediatric Patients (under 5 Years)
Pediatric Glasgow Coma Scale
|Eyes||No eye opening||Eye opening to pain||Eye opening to noise||Eyes open spontaneously|
|0–23 month||No verbal response||Grunts or is agitated or restless||Persistent inappropriate crying when pain||Irritated, crying but consolable||Normal: smiles or coos appropriately|
|2–5 years||No verbal response||Grunts||Persistent cries or screams||Inappropriate words||Appropriate words or phrases|
|Motor||No motor response||Stereotyped extension to pain||Stereotyped flexion to pain||Withdrawal from pain||Withdrawal from touch||Spontaneously|
NB: applied pain: noxious stimulus in an uninjured area.
Example: nail bed pressure with a hard object, or pressure behind vertical branch of mandible.
Glasgow scale insufficient when deep coma because spontaneous eye opening is insufficiently indicative of brainstem arousal system activity
Better predictive value of cerebral trunk function than motor response
|Horizontal oculocephalic (or oculovestibular)||2|
|No brainstem reflex||0|
- Fronto-orbicular = percussion of the glabella (area of the forehead between the eyebrows) produces contraction of the orbicularis oculi muscle
- Oculocephalic reflex (doll's eyes) = present when deviation of at least one eye can be induced by repeated neck flexion and extension (vertical) or side-to-side movement (horizontal)
- If the reflexes are absent or cannot be tested (e.g., immobilized cervical spine), an attempt is made to elicit ocular motion by external auditory canal irrigation using iced water (i.e., oculovestibular reflex testing); contra-indicated if tympanic perforation
- Oculocardiac reflex = present when pressure on the eyeball causes the heart rate to slow down
- The best response determines the brainstem reflex score. The selected reflexes disappear in descending order during rostro–caudal deterioration
1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness.
A practical scale. Lancet.