Glasgow Coma Scale

The Glasgow Coma Scale (GCS) [1] or [2] is a the most commmon neurological assessment scale used to quantify the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury.

• The Glasgow Coma Score is also used as part of the APACHE II assessment score for Critical Care Program and the MOST assessment score for Medicine Program.
• The bedside nurses doing the GCS evaluation on the patient will record the best response. The data collector will look at the first 24 hours of GCS scores and record the worst value of those.

Special notes regarding sedated patients:

• 1. If a pt is an overdose, use the worst score because the sedative effect of the overdose is part of the acuity score.
• 2. If a pt is heavily sedated, a GCS is not considered accurate, therefore, if possible, use the worst GCS done when the pt. is not on sedation in the first 24 hours.
• 3. If a non-sedated GCS is unavailable in the first 24 hours, use the previous un-sedated GCS if possible.
• 4. If there is absolutely no un-sedated GCS available, default to a normal GCS.

• • These instructions were given by Dr Garland utilizing the APACHE manual created by APACHE Medical Systems. --LKolesar 09:02, 2013 January 16 (EST)

Special Cases

The below are only meant to help you use your judgement keeping in mind that the purpose of the GCS is to assess the severity of a brain injury, within the first 24hrs of admission.

Patients with normally limited communication ability

For patients whose ability to communicate are reduced due to pre-existing conditions, score as fully functioning if they are able to function at the level that is normal for this patient. (e.g. Down's syndrome)

Patients who fail assessments for reasons other than consciousness

Patients who are aphasic or intubated but clearly can communicate in writing should be coded as functioning normally. Same is true for patients whose eyes are swollen shut etc. [3]

Medicated Patients

If a patient is unable to respond to GSC questions because they are medicated (e.g. sedated or paralyzed), and there is no reason to expect that their response would be impaired if they were not medicated, they can be scored to a GCS assessment immediately prior to medication if available, e.g. from the ER. If the patient is sedated and there is no documented GCS prior to sedation, you can use a GCS assessment once the sedation is reduced if it is close to the 24 hour mark. If none available then score as NORMAL.

GSC dropdown list and scores

Best Eye

Value	Points
1 none	1
2 to pain	2
3 to speech	3
4 spontaneous	4

Best Motor

Value	Points
1 None	1
2 abn. extension	2
3 abn. flexion	3
4 withdraws to pain	4
5 localizes pain	5
6 obeys commands	6

Best Verbal

Value	Points
1 oriented + conv.	5
2 disoriented + conv.	4
3 inappropriate words	3
4 incomp. Sounds	2
5 no response	1
6 ventilated-appear oriented	5
7 ventilated-?questionably oriented	3
8 ventilated-no response	1

Background

It is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury.

• http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html
• From the other articles referenced,primarily [4]
• http://www.trauma.org/archive/scores/gcs.html
• http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] OR regular wikepedia which is needlessly verbose
• http://reference.medscape.com/calculator/glasgow-coma-scale