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Understanding the Glasgow Coma ScaleThe most commonly used system to quantify a traumatic brain injury patient's level of consciousness is the Glasgow Coma Scale, commonly abbreviated GCS. Although there are other coma scale measurement systems, such as the Rancho Los Amigos Scale, which assesses the level of recovery in brain injury patients, the GCS is the preferred method because it is simple to understand and correlates well with the outcome of a traumatic brain injury. Elements of the Glasgow Coma Scale The GCS score is calculated using three tests, which measure eye opening response, verbal response and motor response. Doctors will look at the three values separately as well as the total score. The lowest possible GCS score is a 3, which indicates a deep coma or brain death. The highest possible score is 15, which is the score of a fully awake, coherent person. As a general rule, the higher the grade for each of the three elements, the better the prognosis of the patient. GCS Eye Response Grades (E) The GCS has four (4) grades for eye response, beginning with the most severe:
GCS Verbal Response Grades (V) The GCS has five (5) grades for verbal response, beginning with the most severe:
GCS Motor Response Grades (M) The GCS has six (6) grades for motor response, beginning with the most severe:
The three individual elements of eye response, verbal response, and motor response of a score are important, as well as the total score. An example score of a patient with a GCS of 10 might be recorded as "GCS 10=E3 V4 M3 at 10:00 a.m." As a general rule, a patient with a GCS score of less than 8 has a severe traumatic brain injury; a patient with a GCS score between 9 and 12 has a moderate traumatic brain injury, and a patient with a GCS score greater than 13 has a minor traumatic brain injury. Limitations of the Glasgow Coma Scale In some circumstances, it may be impossible to calculate a full GCS score. If the patient has orbital fractures and eye injuries, it may not be possible to measure eye-opening response. If the patient has been intubated with an endotracheal tube, they cannot talk, which makes measuring verbal response is impossible. If the patient has a complete spinal cord injury, it will be impossible to measure motor response because the patient will have no feeling or sensation below the level of injury. In these situations, doctors will look at the individual responses that can be measured. The Pediatric Glasgow Coma Scale In infants and young children, especially those younger than three years, the GCS has limited applicability. The Pediatric Glasgow Coma Scale (PGCS) is similar, but developed to assess young children who would not be able to speak and hold a conversation even if they were healthy. The scale values are the same, with 3 being the lowest possible score and 15 being the highest possible score. |
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