Glasgow Coma Scale (GCS)

It was developed by Sir Graham Teasdale, Emeritus Professor of Neurology, University of Glasgow.
it was first described in 1974
The Glasgow Coma Scale provides a practical method for assessment of impairment of conscious
level in response to defined stimuli.
The Glasgow Coma Scale[1] (GCS) is a clinical scale used to reliably measure a person's level of
consciousness after a brain injury.
The GCS assesses a person based on their ability to perform eye movements, speak, and move their
body. These three behaviors make up the three elements of the scale: eye, verbal, and motor.
A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is
used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor
hospitalized patients and track their level of consciousness.

THE SCALE

Eye Opening Response

• Spontaneous--open with blinking at baseline 4 points

• To verbal stimuli, command, speech 3 points

• To pain only (not applied to face) 2 points

• No response 1 point

Verbal Response

• Oriented 5 points

• Confused conversation, but able to answer questions 4 points

• Inappropriate words 3 points

• Incomprehensible speech 2 points

• No response 1 point

Motor Response

• Obeys commands for movement 6 points

• Purposeful movement to painful stimulus 5 points

• Withdraws in response to pain 4 points

• Flexion in response to pain (decorticate posturing) 3 points

• Extension response in response to pain (decerebrate posturing) 2 points

• No response 1 point

USED IN:
This scale helps to gauge the impact of a wide variety of conditions such as acute brain damage due to
traumatic and/or vascular injuries or infections, metabolic disorders (e.g., hepatic or renal failure,
hypoglycemia, diabetic ketosis), etc.

VARIATION

SCORING
The results are reported as the Glasgow Coma Score (the total points from the three tests) and the individual
components. As an example, a person's score might be: GCS 12, E3 V4 M5. Alternatively, if a patient was
intubated, their score could be GCS E2 V NT M3.

Head Injury Classification:

Severe Head Injury----GCS score of 8 or less

Moderate Head Injury----GCS score of 9 to 12

Mild Head Injury----GCS score of 13 to 15

(Adapted from: Advanced Trauma Life Support: Course for Physicians, American

College of Surgeons, 1993).

LIMITATION
scale's poor inter-rater reliability and lack of prognostic utility.[25]

Although there is no agreed-upon alternative, newer scores such as the Simplified motor scale and FOUR
score have also been developed as improvements to the GCS.[26] Although the inter-rater reliability of these
newer scores has been slightly higher than that of the GCS, they have not gained consensus as replacements.
 RELIABILITY
The inter-rater reliability of the total Glasgow Coma Scale is p = 0.86. Some research has subdivided the inter-
rater reliability for each subscale. For the eye score the inter-rater reliability is p = 0.76, the verbal score is p =
0.67, and the motor score is p=0.81. [10] The research for test-retest reliability is not recent and should be
updated, however, the best available evidence is k = 0.66 - 0.77. [11]

Based on a recent systematic review, the total score is typically less reliable than the individual components
with a total Kappa value of 77% as compared to the eye, motor, and verbal scores which had Kappa values of
89%, 94%, and 88% respectively

VALIDITY
The validity of the Glasgow Coma Scale comes under fire because a lot of hospitals administer the test while
patients have been sedated, often underestimating patient scores. It’s also difficult to elicit accurate scores
when patients are intubated