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. Due to this use as part of APACHE we need the best GCS in the first 24 hrs (unlike all other APACHE elements). Consciousness is greatly affected by sedative drugs, and many/most patients get such drugs. So being totally unconscious can easily be a result of being sedated, not brain-injured. Since this issue is even bigger than the issue of waxing/waning mental status due to fluctuating/changing illness, we use the best value in the 1st 24 hrs.
Instructions
Select the best Eye, Motor or Verbal response in the first 24 hours after admission to ICU from the dropdown lists in CCMDB.mdb.
- I understand that many patients are sedated and therefore the best response in the first 24 hours would make sense. In the event that no sedation was given, should we still pick the best response in the first 24 hours or the worst? Just want to make sure I understand this correctly as it has been very confusing to date. Are there any reference articles to refer to? --LKolesar 18:53, 2012 December 9 (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