Glasgow Coma scale - wikipedia Glasgow Coma scale Not to be confused with Glasgow Outcome Scale. Glasgow Coma Scale Medical diagnostics MeSH D015600 LOINC 35088 - 4 ( edit on Wikidata ) The Glasgow Coma Scale ( GCS ) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 ( indicating deep unconsciousness ) and either 14 ( original scale ) or 15 ( more widely used modified or revised scale ). GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first responders, EMS, nurses, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care. The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow 's Institute of Neurological Sciences at the city 's Southern General Hospital. GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system, as it was designed for. The initial indication for use of the GCS was serial assessments of patients with traumatic brain injury and coma for at least 6 hours in the neurosurgical ICU setting, though it is commonly used throughout hospital departments. A similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients. GCS was updated following a review of the helpfulness and usefulness of the scale from Clinicians. It was decided that several things required updating, like the Eye Response element, meaning that instead of responding to `` Painful Stimuli '' being regarded as a 2, a patient that opens their eyes in response to pressure is now considered a 2 in the Eye Response element. Contents 1 Elements of the scale 1.1 Eye response ( E ) 1.2 Verbal response ( V ) 1.3 Motor response ( M ) 2 Interpretation 3 Revisions 4 Controversy 5 See also 6 References 7 External links Elements of the scale Glasgow Coma Scale 5 6 Eye Does not open eyes Opens eyes in response to pain Opens eyes in response to voice Opens eyes spontaneously N / A N / A Verbal Makes no sounds Makes sounds Words Confused, disoriented Oriented, converses normally N / A Motor Makes no movements Extension to painful stimuli ( decerebrate response ) Abnormal flexion to painful stimuli ( decorticate response ) Flexion / Withdrawal to painful stimuli Localizes to painful stimuli Obeys commands Note that a motor response in any limb is acceptable. The scale is composed of three tests : eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS ( the sum ) is 3 ( deep coma or death ), while the highest is 15 ( fully awake person ). Eye response ( e ) There are four grades starting with the most severe : No eye opening Eye opening in response to pain stimulus. ( a peripheral pain stimulus, such as squeezing the lunula area of the patient 's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect ). Eye opening to speech. ( Not to be confused with the awakening of a sleeping person ; such patients receive a score of 4, not 3. ) Eyes opening spontaneously Verbal response ( v ) There are five grades starting with the most severe : No verbal response Incomprehensible sounds. ( Moaning but no words. ) Inappropriate words. ( Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences. ) Confused. ( The patient responds to questions coherently but there is some disorientation and confusion. ) Oriented. ( Patient responds coherently and appropriately to questions such as the patient 's name and age, where they are and why, the year, month, etc. ) Motor response ( M ) There are six grades : No motor response Decerebrate posturing accentuated by pain ( extensor response : adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot ) Decorticate posturing accentuated by pain ( flexor response : internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot ) Withdrawal from pain ( absence of abnormal posturing ; unable to lift hand past chin with supraorbital pain but does pull away when nailbed is pinched ) Localizes to pain ( purposeful movements towards painful stimuli ; e.g., brings hand up beyond chin when supraorbital pressure applied ) Obeys commands ( the patient does simple things as asked ) Interpretation Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form `` GCS 9 = E2 V4 M3 at 07 : 35 ''. Generally, brain injury is classified as : Severe, GCS < 8 -- 9 Moderate, GCS 8 or 9 -- 12 ( controversial ) Minor, GCS ≥ 13. Tracheal intubation and severe facial / eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached ( e.g. `` E1c '', where `` c '' = closed, or `` V1t '' where t = tube ). Often the 1 is left out, so the scale reads Ec or Vt. A composite might be `` GCS 5tc ''. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for `` abnormal flexion ''. The GCS has limited applicability to children, especially below the age of 36 months ( where the verbal performance of even a healthy child would be expected to be poor ). Consequently, the Pediatric Glasgow Coma Scale was developed for assessing younger children. Revisions Glasgow Coma Scale : While the 15 - point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14 - point scale, omitting the category of `` abnormal flexion ''. Some centres still use this older scale, but most ( including the Glasgow unit where the original work was done ) have adopted the modified one. The Rappaport Coma / Near Coma Scale made other changes. Meredith W., Rutledge R, Fakhry SM, EMery S, Kromhout - Schiro S have proposed calculating the verbal score based on the measurable eye and motor responses. The most widespread revision has been the Simplified Motor and Verbal Scales which shorten the respective sections of the GCS without loss of accuracy. The GCS for intubated patients is scored out of 10 as the verbal component falls away Controversy The GCS has come under pressure from some researchers who take issue with the scale 's poor inter-rater reliability and lack of prognostic utility. 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. 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. See also AVPU scale Blantyre coma scale Early warning score Paediatric Glasgow Coma Scale Rancho Los Amigos Scale Revised Trauma Score Triage References Jump up ^ Teasdale G, Jennett B ( 1974 ). `` Assessment of coma and impaired consciousness. A practical scale ''. Lancet. 2 ( 7872 ) : 81 -- 4. doi : 10.1016 / S0140 - 6736 ( 74 ) 91639 - 0. PMID 4136544. Jump up ^ `` What 's new - Glasgow Coma Scale ''. www.glasgowcomascale.org. Retrieved 2018 - 06 - 24. Jump up ^ Russ Rowlett. `` Glasgow Coma Scale ''. University of North Carolina at Chapel Hill. Jump up ^ Hutchinson 's clinical methods 22nd edition Jump up ^ `` The Glasgow Coma Scale : clinical application in Emergency Departments ''. Emergency Nurse. 14 ( 8 ) : 30 -- 5. 2006. doi : 10.7748 / en2006. 12.14. 8.30. c4221. Jump up ^ https://www.cdc.gov/masstrauma/resources/gcs.pdf Jump up ^ Gill M, Windemuth R, Steele R, Green SM ( 2005 ). `` A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes ''. Ann Emerg Med. 45 ( 1 ) : 37 -- 42. doi : 10.1016 / j. annemergmed. 2004.07. 429. PMID 15635308. Jump up ^ Green S.M. ( 2011 ). `` Cheerio, Laddie ! Bidding Farewell to the Glasgow Coma Scale ''. Annals of Emergency Medicine. 58 ( 5 ) : 427 -- 430. doi : 10.1016 / j. annemergmed. 2011.06. 009. PMID 21803447. Jump up ^ Iver, VN ; Mandrekar, JN ; Danielson, RD ; Zubkov, AY ; Elmer, JL ; Wijdicks, EF ( 2009 ). `` Validity of the FOUR score coma scale in the medical intensive care unit ''. Mayo Clinic Proceedings. 84 ( 8 ) : 694 -- 701. doi : 10.4065 / 84.8. 694. PMC 2719522. PMID 19648386. Jump up ^ Fischer, M ; Rüegg, S ; Czaplinski, A ; Strohmeier, M ; Lehmann, A ; Tschan, F ; Hunziker, PR ; Marschcorresponding, SC ( 2010 ). `` Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients : a prospective observational study ''. Critical Care. 14 ( 2 ) : R -- 64. doi : 10.1186 / cc8963. PMC 2887186. PMID 20398274. Teasdale G, Murray G, Parker L, Jennett B ( 1979 ). `` Adding up the Glasgow Coma Score ''. Acta Neurochir Suppl ( Wien ). 28 ( 1 ) : 13 -- 6. doi : 10.1007 / 978 - 3 - 7091 - 4088 - 8_2. PMID 290137. Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout - Schiro S ( 1998 ). `` The conundrum of the Glasgow Coma Scale in intubated patients : a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores ''. J Trauma. 44 ( 5 ) : 839 -- 44 ; discussion 844 -- 5. doi : 10.1097 / 00005373 - 199805000 - 00016. PMID 9603086. External links Website to calculate the Glasgow Coma Scale Glasgow Coma Scale Calculator Glasgow + Coma + Scale at the US National Library of Medicine Medical Subject Headings ( MeSH ) Dr. Graham Teasdale speaks with The Lancet - podcast, August 2014 Glasgow Coma Scale at 40 Simplified Motor Score Glasgow Coma Scale Calculator for OS Android Intensive care medicine Health science Medicine Medical specialities Respiratory therapy General terms Intensive care unit ( ICU ) Neonatal intensive care unit ( NICU ) Pediatric intensive care unit ( PICU ) Coronary care unit ( CCU ) Critical illness insurance Conditions Organ system failure Shock sequence SIRS Sepsis Severe sepsis Septic shock Multiple organ dysfunction syndrome Other shock Cardiogenic shock Distributive shock Anaphylaxis Obstructive shock Neurogenic shock Spinal shock Organ failure Acute renal failure Acute respiratory distress syndrome Acute liver failure Respiratory failure Multiple organ dysfunction syndrome Neonatal infection Polytrauma Coma Complications Critical illness polyneuropathy / myopathy Critical illness -- related corticosteroid insufficiency Decubitus ulcers Fungemia Stress hyperglycemia Stress ulcer Iatrogenesis Methicillin - resistant Staphylococcus aureus Oxygen toxicity Refeeding syndrome Ventilator - associated lung injury Ventilator - associated pneumonia Dialytrauma Diagnosis Arterial blood gas Catheter Arterial line Central venous catheter Pulmonary artery catheter Blood cultures Screening cultures Life - supporting treatments Airway management Chest tube Dialysis Enteral feeding Goal - directed therapy Induced coma Mechanical ventilation Therapeutic hypothermia Total parenteral nutrition Tracheal intubation Drugs Analgesics Antibiotics Antithrombotics Inotropes Intravenous fluids Neuromuscular - blocking drugs Recombinant activated protein C Sedatives Stress ulcer prevention drugs Vasopressors ICU scoring systems APACHE II Glasgow Coma Scale PIM2 SAPS II SAPS III SOFA Physiology Hemodynamics Hypotension Level of consciousness Acid -- base imbalance Water - electrolyte imbalance Organisations Society of Critical Care Medicine Surviving Sepsis Campaign European Society of Paediatric and Neonatal Intensive Care Related specialties Anesthesia Cardiology Internal medicine Neurology Pediatrics Pulmonology Surgery Traumatology Neurosurgical and other procedures ( ICD - 9 - CM V3 01 -- 05 + 89.1, ICD - 10 - PCS 00 -- 01 ) Skull Craniotomy Decompressive craniectomy Cranioplasty CNS Brain thalamus and globus pallidus : Thalamotomy Thalamic stimulator Pallidotomy ventricular system : Ventriculostomy Suboccipital puncture Intracranial pressure monitoring cerebrum : Psychosurgery Lobotomy Bilateral cingulotomy Hemispherectomy Anterior temporal lobectomy pituitary gland : Hypophysectomy hippocampus : Amygdalohippocampectomy Brain biopsy Cerebral meninges Meningeal biopsy Spinal cord and spinal canal Spinal cord and roots Cordotomy Rhizotomy Vertebrae and intervertebral discs : see Template : Bone, cartilage, and joint procedures Medical imaging Computed tomography of the head Cerebral angiography Pneumoencephalography Echoencephalography / Transcranial Doppler Magnetic resonance imaging of the brain Brain PET Myelography Diagnostic Electroencephalography Lumbar puncture Polysomnography CPRs Glasgow Coma Scale Mini -- mental state examination National Institutes of Health Stroke Scale CHADS2 score PNS Cranial and peripheral nerves Nerve block Vagotomy Sympathetic nerves or ganglia Ganglionectomy Sympathectomy Endoscopic thoracic sympathectomy Nerves ( general ) Axotomy Neurectomy Nerve biopsy Diagnostic Nerve conduction study Electromyography Medical imaging Magnetic resonance neurography Retrieved from `` https://en.wikipedia.org/w/index.php?title=Glasgow_Coma_Scale&oldid=854022399 '' Categories : Emergency medicine Intensive care medicine Neuropsychological tests Medical scales Memory tests Scottish inventions Coma Medical assessment and evaluation instruments Talk Contents About Wikipedia Azərbaycanca Català Čeština Dansk Deutsch Español فارسی Français Hrvatski Bahasa Indonesia Italiano עברית Nederlands 日本 語 Norsk Polski Português Русский Simple English Slovenščina Srpskohrvatski / српскохрватски Suomi Svenska ไทย Türkçe Українська اردو Tiếng Việt 中文 21 more Edit links This page was last edited on 8 August 2018, at 12 : 47 ( UTC ). 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Question: a patient in the deepest coma would be scored a on the glasgow coma scale
Answer: 3