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Glasgow Coma Scale
The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing 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 all acute medical and trauma patients. In hospital it is also used in chronic patient monitoring, in for instance, intensive care.
The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow. The pair went on to author the textbook Management of Head Injuries (FA Davis 1981, ISBN 0-8036-5019-1), a celebrated work in the field.
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. A similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients.
Additional recommended knowledge
Elements of the scale
The scale comprises 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), whilst the highest is 15 (fully awake person).
Best eye response (E)
There are 4 grades starting with the most severe:
Best verbal response (V)
There are 5 grades starting with the most severe:
Best motor response (M)
There are 6 grades starting with the most severe:
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, comas are classified as:
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'.
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 Paediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Glasgow_Coma_Scale". A list of authors is available in Wikipedia.|