Glasgow Coma Scale (GCS)

Tip: When taking the NBCOT Exam, you will get a scratch paper (whiteboard). I highly recommend calculating the Glasgow Coma Scale (GCS) by hand instead of mentally to reduce making an error. The GCS assesses the level of consciousness in patients and can be an effective instrument to monitor trends in the level of consciousness.

History

The development of the GCS began in 1971. The research took place in Glasgow, UK. There was a need for an effective communication tool between hospitals and specialty units and a way to measure a patient’s state at admission compared to their outcome. With a growing interest in traumatic injury and its pathophysiology and the rapid expansion of ICUs, there needed to be an interdisciplinary communication method that was standardized to report initial severity and outcome. The GCS is used by neurosurgeons and other health professionals and is the only method for assessing brain injuries in 80% of these countries.¹ 

GCS Scale

Eye Opening
4	Spontaneous
3	To speech
2	To pain
1	No response

Verbal Response
5	Oriented (person, time place)
4	Confused
3	Incomprehensible words
2	Incomprehensible sounds
1	No response

Motor Response
6	Obeys command
5	Localizes pain
4	Withdraws from pain
3	Abnormal flexion (decorticate rigidity)
2	Abnormal extension (decerebrate rigidity)
1	No response

Lowest possible score: 3 Highest possible score: 15 Mneumonic: G – Gaze (eye-opening) C – Conversation (verbal response) S – Sensation/sensory (motor response to sensory command)

Practice

Practice scoring and interpreting the severity of the level of consciousness with the GCS calculator.

Research

Components of the Glasgow Coma Scale and the overall score are strongly related to outcomes after acute brain damage.²  “Data from more than 1 million injured people in the USA National Trauma Data Bank shows that the initial Glasgow Coma Score correlated with outcomes across the full range of trauma severity, with mortality rising from 1% at a Glasgow Coma Score of 15 to 27% at a score of 4.”³  Bookmark

1. Teasdale, G., Maas, A., Lecky, F., Manley, G., Stocchetti, N., & Murray, G. (2014). The Glasgow Coma Scale at 40 years: standing the test of time. The Lancet Neurology, 13(8), 844-854.[↩]
2. Chesnut RM, Ghajar J, Maas AIR, et al. Part 2: early indicators of prognosis in severe traumatic brain injury. J Neurotrauma 2000; 17: 557–626.[↩]
3. Teasdale, G., Maas, A., Lecky, F., Manley, G., Stocchetti, N., & Murray, G. (2014). The Glasgow Coma Scale at 40 years: standing the test of time. The Lancet Neurology, 13(8), 844-854.[↩]