Glasgow coma scale: Difference between revisions
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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]], a separate yet closely related scale, was developed for assessing younger children. | 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]], a separate yet closely related scale, was developed for assessing younger children. | ||
==Disclaimer== | |||
Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glascow Coma Scale was designed and should be used to assess the depth and duration coma and impaired consciousness. 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.<ref>{{Cite web | last = | first = | title = http://www.bt.cdc.gov/masscasualties/pdf/glasgow-coma-scale.pdf | url = http://www.bt.cdc.gov/masscasualties/pdf/glasgow-coma-scale.pdf | publisher = | date = | accessdate = }}</ref> | |||
==Revisions== | ==Revisions== | ||
Revision as of 18:34, 8 March 2014
| Glasgow coma scale |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
The Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, 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 (the 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 aid, EMS, 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.
Elements of the scale
| Eye Opening | Spontaneous | 4 |
| To Verbal Command | 3 | |
| To Pain | 2 | |
| None | 1 | |
| Best Verbal Response | Oriented | 5 |
| Confused | 4 | |
| Inappropriate Words | 3 | |
| Incomprehensive Sounds | 2 | |
| None | 1 | |
| Best Motor Response | Obeys Commands | 6 |
| Localizes Pain | 5 | |
| Withdraws from Pain | 4 | |
| Flexion to Pain | 3 | |
| Extension to Pain | 2 | |
| None | 1 | |
| GCS-Score | 3-15 | |
| GCS > 8 = Somnolent | ||
| >12 | Mild | |
| 12-9 | Moderate | |
| Somnolence: Sleepy, easy to wake | ||
| Stupor: Hypnoid, hard to wake | ||
| GCS < 8 = Unconscious | ||
| 8-7 | Coma Grade I | Light Coma |
| 6-5 | Coma Grade II | Light Coma |
| 4 | Coma Grade III | Deep Coma |
| 3 | Coma Grade IV | Deep Coma |
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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, with GCS < 8-9
- Moderate, GCS 8 or 9–12 (controversial)[1]
- Minor, GCS ≥ 13.
Generally when a patient is in a decline of their GCS score, the nurse or medical staff should assess the cranial nerves and determine which of the twelve have been affected.
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. 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". Often the 1 is left out, so the scale reads Ec or Vt.
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, a separate yet closely related scale, was developed for assessing younger children.
Disclaimer
Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glascow Coma Scale was designed and should be used to assess the depth and duration coma and impaired consciousness. 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.[2]
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.
Controversy
The GCS has come under pressure from some researchers that take issue with the scale's issues, such as poor inter-rater reliability and lack of prognostic utility.[3] Although there is not an agreed upon alternative, newer scores such as the Simplified motor scale and FOUR score have also been developed as improvements to the GCS.[4] While inter-rater reliability of these newer scores have been slightly higher than the GCS, they were not significant enough to gain consensus as a replacement.[5]
See also
External links
- Website to calculate the Glasgow Coma Scale
- Glasgow+Coma+Scale at the US National Library of Medicine Medical Subject Headings (MeSH)
- An Android app to calculate GCS / PGCS
References
- ↑ reference
- ↑ "http://www.bt.cdc.gov/masscasualties/pdf/glasgow-coma-scale.pdf" (PDF). External link in
|title=(help) - ↑ Green, S. M. (2011). Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of emergency medicine, 58(5), 427_430. Elsevier Inc. doi:10.1016/j.annemergmed.2011.06.009
- ↑ 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. PMID 19648386.
- ↑ 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". BioMed Central: Critical Care. 14 (2): R-64. PMC 2887186.
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]