Glasgow Coma Scale

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The Glasgow Coma Scale (GCS) ([1], [2]) is a 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 ALERT Scale for Medicine Program.
  • The bedside nurses doing the GCS evaluation on the patient will record the best response.
  • The data collector will enter the GCS as per Selection and timing of APACHE components

Special notes regarding sedated patients:

  1. If a pt is an overdose, use the worst score because the sedative effect and the potential injury to the brain due to the drug 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.

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/Sedated Patients

For sedated patients, also see GCS sedated field.

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

Implementation

In CCMDB:

  • L_Log populated by lookup from s_GCS:
    • ap_eye text(13) lookup "1 None;2 To Pain;3 To Speech;4 Spontaneous"
    • ap_motor text(19) lookup "1 None;2 Abn. Extension;3 Abn Flexion;4 Withdraws to Pain;5 Localizes Pain;6 Obeys Commands"
    • ap_verbal text(26) lookup "1 Oriented+Conv;2 Disoriented+Conv;3 Inappropriate Words;4 Incomp. Sound;5 No response;6 vented-appears oriented;7 vented-? oriented;8 vented-no response"
      • The list sorting numbers for this one are opposite to scoring

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.

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