The Glasgow Coma Scale 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 the Glasgow Coma Score (or GCS). Neurology is a branch of medicine dealing with disorders of the nervous system. ... The concept of scale is applicable if a system is represented proportionally by another system. ...

Initially used to assess level of consciousness after head injury, the scale is actually applied to different situations. 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. Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... Year 1974 (MCMLXXIV) was a common year starting on Tuesday (link will display full calendar) of the 1974 Gregorian calendar. ... Master of Theology (MTh) Dentistry Nursing Affiliations Russell Group Universitas 21 Website http://www. ... Year 1981 (MCMLXXXI) was a common year starting on Thursday (link displays the 1981 Gregorian calendar). ...

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. There are several scoring systems in intensive care units (ICUs) today. ... APACHE II is a well validated system for rating the severity of medical illness. ... SAPS II is a severity of disease classification system (Le Gall, Lemeshow, Saulnier, 1993). ... The SOFA score is used to track a patients status during the stay in an intensive care unit. ... A diagram showing the CNS: 1. ... == == {| class=wikitable |- Headline text |}{| class=wikitable |- ! header 1 ! header 2 ! header 3 |- | row 1, cell 1 | row 1, cell 2 | row 1, cell 3 |- | row 2, cell 1 | row 2, cell 2 | row 2, cell 3 |} == == The Rancho Los Amigos Scale (a. ... Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. ...

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). In psychology, visual perception is the ability to interpret visible light information reaching the eyes which is then made available for planning and action. ... Bold text This article does not cite any references or sources. ... A motor skill is a skill that requires an organism to utilize their skeletal muscles effectively in a goal directed manner. ... For other uses, see Coma (disambiguation). ... For other uses, see Death (disambiguation), Dead (disambiguation), or Death (band). ...

Best eye response (E)

There are 4 grades starting with the most severe:

1. No eye opening
2. Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
3. Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
4. Eyes opening spontaneously

Pain redirects here. ... Nails: left hand, adult human male Anatomy In anatomy, a nail is a horn-like piece at the end of an animal finger or toe. ... Supraorbital ridges seen in Australopithecus africanus The supraorbital ridge, supraorbital torus, superciliary ridge, arcus superciliaris, or brow ridge, refer to a bony ridge located above the eye sockets of all primates. ... The sternum (from Greek στέρνον, sternon, chest) or breastbone is a long, flat bone located in the center of the thorax (chest). ...

Best verbal response (V)

There are 5 grades starting with the most severe:

1. No verbal response
2. Incomprehensible sounds. (Moaning but no words.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
5. 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.)

Best motor response (M)

There are 6 grades starting with the most severe:

1. No motor response
2. Extension to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response)
3. Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
4. Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
5. Localizes to pain. (Purposeful movements towards painful stimuli; e.g. hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
6. Obeys commands. (The patient does simple things as asked.)

In anatomy and physiology, adduction is the moving of limbs towards the midline of the body. ... In human and zoological anatomy (sometimes called zootomy), several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... The leg extension is an isolation exercise. ... The decerebrate response is a medical term for the involuntary extending of the upper extremities in response to external stimuli. ... In anatomy and physiology, adduction is the moving of limbs towards the midline of the body. ... In human and zoological anatomy (sometimes called zootomy), several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... In anatomy, Flexion is movement whereby bones or other objects are brought closer together. ... The decorticate response is a medical term for the involuntary flexing of the upper extremities in response to external stimuli. ... In anatomy, Flexion is movement whereby bones or other objects are brought closer together. ... In human and zoological anatomy (sometimes called zootomy), several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... In anatomy, Flexion is movement whereby bones or other objects are brought closer together. ... Collarbone and collar bone redirect here. ...

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, comas are classified as:

• Severe, with GCS ≤ 8
• Moderate, GCS 9 - 12
• Minor, GCS ≥ 13.

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. The Paediatric Glasgow Coma Scale (also known as Paediatric Glasgow Coma Score or simply PGCS) is the equivalent of the Glasgow Coma Scale used to assess the mental state of adult patients. ...

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.

See also

• Blantyre Coma Scale
• Rancho Los Amigos Scale
• Pediatric Glasgow Coma Scale
• Revised Trauma Score

The Blantyre Coma Scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children. ... == == {| class=wikitable |- Headline text |}{| class=wikitable |- ! header 1 ! header 2 ! header 3 |- | row 1, cell 1 | row 1, cell 2 | row 1, cell 3 |- | row 2, cell 1 | row 2, cell 2 | row 2, cell 3 |} == == The Rancho Los Amigos Scale (a. ... The Pediatric Glasgow Coma Scale (also known as Pediatric Glasgow Coma Score or simply PGCS) is the equivalent of the Glasgow Coma Scale used to assess the mental state of adult patients. ... The Revised Trauma Score (RTS) is a tool for on-site triage for Multiple Casualty Incidents. ...

References

• Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. PMID 4136544.

The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ...

External links

• Website to calculate the Glasgow Coma Scale
• MeSH Glasgow+Coma+Scale