ADDONS / SCALES
Glasgow Coma Scale (GCS)
David Goldemund M.D.
Updated on 23/07/2024, published on 20/02/2024
- Glasgow Coma Scale (GCS) is an objective and reliable tool for assessing patients´ level of consciousness based on their response to defined stimuli; it is used in acute medical and trauma patients
- GCS evaluates three aspects of responsiveness: eye-opening (E), verbal response (V), and motor response (M)
- interfering factors must be considered (intubated or aphasic patients, factors such as sedation, alcohol or drug influence)
- stimulation used:
- sound: spoken or shouted request
- physical: pressure applied to the fingertip, trapezius, or supraorbital notch
- score the highest observed response
- the GCS has been incorporated into numerous clinical guidelines and scoring systems
- in the setting of head trauma, a GCS score of ≤ 8 on admission represents severe traumatic brain injury (TBI)
- scores range from 3 to 15, with a normal finding being GCS 15 (E4V5M6)
- in 2018, an updated version of the GCS called the “GCS-P” was published (the P stands for “pupil”) (Brennan, 2018)
- this is a fourth number that providers subtract from the standard GCS score ⇒ GCS-P score can range from 1 to 15
- a GCS score of 3 and a pupil score of 2 is a GCS-P score of 1; that means a very deep coma with no pupil reaction in both eyes)
- the pupil scores mean:
- 2 = neither pupil reacts to light
- 1 = one pupil doesn’t react to light
- 0 = both pupils react to light
- GCS-P 1 and 2 extend the information about injury severity
- the GCS-P score still uses a score of 8 or fewer to mean a coma
Glasgow Coma Scale (GCS 3-15) | |
Eye-opening |
|
4 | spontaneous |
3 | response to a verbal command |
2 | response to pain/pressure |
1 | none (eyes don’t open for any reason) |
Verbal response | |
5 | oriented (oriented; correctly gives name, place, and date) |
4 | confused (not orientated but communicating coherently) |
3 | inappropriate words (single intelligible words) |
2 | incomprehensible sounds (moans/groans only) |
1 | no verbal response |
Motor response | |
6 | obeys commands |
5 | localizes pain (targeted defense reaction) |
4 | reflex withdrawal from pain |
3 | decorticate posturing – arms are flexed at the elbows and held inward and close to the body; the legs and feet are extended and turned inward |
2 | decerebrate posturing – rigidity with arm and leg extension, wrist flexion, and foot plantar flexion → Decorticate and decerebrate posturing |
1 | no motor response |