Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciouness following a traumtic brain injury. [1] 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.
Instructions
Select the best Eye, Motor or Verbal response in the first 24 hours after admission to ICU from the dropdown lists on your PDA and in Access.
For reference only:
| Score | 6 | 5 | 4 | 3 | 2 | 1 |
| EYE Response | Spontaneous | To
Speech |
To
Pain |
None | ||
| MOTOR Response | Obeys
Command |
Localizes
Pain |
Withdraws
to Pain |
Abnormal
Flexion |
Abnormal
Extension |
None |
| VERBAL Response | Oriented | Confused | Inappropriate
words |
Incomprehensible
sounds |
None | |
| VERBAL Response -Ventilated | Appears Oriented | ? Oriented | No response |
Special Cases
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 cannot speak but are communicating
Patients who are aphasic or intubated but clearly can communicate in writing should be coded as functioning normally for Verbal assessment.
Sedated or Paralyzed Patients
For non-neuro and post operative patients who are sedated or paralyzed, record a 'normal GCS score unless there are concerns in regards brain injury. Sedation does not allow us to accurately assess neuological status therefore we use alternative information that was documented prior to OR or sedation or we use our "best guess" based on chart notes.
Discussion
- I think that one might weave back and forth too much and be a bit hard to read. How about this:
Being sedated or paralyzed may not allow us to accurately assess neurological status. For sedated or paralyzed patients consider their likely neurological status prior to sedation or paralysis or status when sedation wears off.
- when using information that was documented prior to sedation/paralysis or POST OP use "best guess" based on chart notes.
- Even if my version is not adopted, we do need to state how to score in case of brain injury. Ttenbergen 17:15, 18 June 2008 (CDT)Use GSC to assess brain injury.
- This was touched upon in the Category:Critical Care Review Group. Ttenbergen 14:08, 16 October 2008 (CDT)
Patients following drug overdose where outcome uncertain
Discussion
What should be coded for patients who had a drug overdose where the outcome is not clear during the GCS time frame? Ttenbergen 14:10, 16 October 2008 (CDT)
Discussion
- see entries above.Ttenbergen 14:09, 16 October 2008 (CDT)
- Could we improve the definition to reduce the special cases. Ttenbergen 14:13, 16 October 2008 (CDT)