Glasgow Coma Scale (GCS) Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What is Glasgow Coma Scale (GCS) used to measure?

A

The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person’s level of consciousness after a brain injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What abilities does the GCS assess?

What does is the total score’s range?

How do you report specific tests that cannot be performed?

A

The Glasgow Coma Scale is reported as the combined score (which ranges from 3 to 15) and the score of each test (E for eye, V for Verbal, and M for Motor).

The scale also accounts for situations that prevent appropriate testing (Not Testable). When specific tests cannot be performed, they must be reported as “NT” and the total score is not reported.

As an example, a person’s score might be: GCS 12, E3 V4 M5. Alternatively, if a patient was intubated, their score could be GCS E2 V NT M3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Eye response (E)

A

There are four grades starting with the most severe:

  1. No opening of the eye
  2. Eye opening in response to pain stimulus. A peripheral pain stimulus, such as squeezing the lunula area of the person’s fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect.
  3. Eye opening to speech. Not to be confused with the awakening of a sleeping person; such people receive a score of 4, not 3.
  4. Eyes opening spontaneously

NT (Not testable). Examples for this would include severe damage to the eyes, sedation from drugs, and paralysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Verbal response (V)

A

There are five grades starting with the most severe:

  1. No verbal response
  2. Incomprehensible sounds. Moaning but no words.
  3. Inappropriate words. Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.
  4. Confused. The person responds to questions coherently but there is some disorientation and confusion.
  5. Oriented. Person responds coherently and appropriately to questions such as the person’s name and age, where they are and why, the year, month, etc.

NT (Not testable). Examples for this would include intubation, deafness, language barrier, sedation from drugs, and paralysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Motor response (M)

A

There are six grades starting with the most severe:

  1. No motor response. Lack of any motor response should raise suspicion for spinal cord injury.
  2. Abnormal Extension in response to pain. Different guidelines report different evaluation of abnormal extension. While some sources indicate extension at the elbow is sufficient, other sources use the language “decerebrate posturing”. It is important to note that the original publication of the Glasgow Coma Scale explicitly avoided the term “decerebrate extension” because it implied specific anatomical findings.
  3. Abnormal Flexion in response to pain. Different guidelines report different evaluation. While some sources focus on arm movements, other sources use the term “decorticate posturing”.
  4. Normal Flexion (absence of abnormal posturing; unable to lift hand past chin with supraorbital pain but does pull away when nailbed is pinched)
  5. Localizes to pain (purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supraorbital pressure applied)
  6. Obeys commands (the person does simple things as asked)

NT (Not testable). Examples for this would include spinal cord injury, sedation from drugs, and paralysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Interpretation of GCS

A

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form “GCS 9 = E2 V4 M3 at 07:35”. Patients with scores of 3-8 are usually considered to be in a coma. Generally, brain injury is classified as:

  • Severe, GCS < 8–9
  • Moderate, GCS 8 or 9–12 (controversial)
  • Minor, GCS ≥ 13.

Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. “E1c”, where “c” = closed, or “V1t” where t = tube). Often the 1 is left out, so the scale reads Ec or Vt. A composite might be “GCS 5tc”. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for “abnormal flexion”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly