8/8/2019 Glasgow Coma Score

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Glasgow Coma Score

Eye Opening (E) Verbal Response (V) Motor Response (M)

4=Spontaneous

3=To voice

2=To pain1=None

5=Normal conversation

4=Disoriented conversation

3=Words, but not coherent2=No words......only sounds1=None

6=Normal

5=Localizes to pain

4=Withdraws to pain3=Decorticate posture2=Decerebrate

1=None

Total = E+V+M

The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of

consciousness following traumatic brain injury. It is used primarily because it is simple, has a

relatively high degree of interobserver reliability and because it correlates well with outcomefollowing severe brain injury.

It is easy to use, particularly if a form is used with a table similar to the one above. One

determines the best eye opening response, the best verbal response, and the best motor response.The score represents the sum of the numeric scores of each of the categories. There are

limitations to its use. If the patient has an endotracheal tube in place, they cannot talk. For thisreason, many prefer to document the score by its individual components; so a patient with a

Glasgow Coma Score of 15 would be documented as follows: E4 V5 M6. An intubated patientwould be scored as E4 Vintubated M6. Of these individual factors, the best motor response is

probably the most significant.

Other factors which alter the patients level of consciousness interfere with the scale's ability to

acurately reflect the severity of a traumatic brain injury. So, shock, hypoxemia, drug use, alcoholintoxication, metabolic disturbances may alter the GCS independently of the brain injury.

Obviously, a patient with a spinal cord injury will make the motor scale invalid, and severeorbital trauma may make eye opening impossible to assess. The GCS also has limited utility in

children, particularly those less than 36 months. In spite of these limitations, it is quite useful andis far and away the most widely used scoring system used today to assess patients with traumatic

brain injury.

Eye Opening E

spontaneous 4

to speech 3

to pain 2

no response 1

8/8/2019 Glasgow Coma Score

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Best Motor Response M

To Verbal Command:

obeys 6

To Painful Stimulus:

localizes pain 5

flexion-withdrawal 4

flexion-abnormal 3

extension 2

no response 1

Best Verbal Response V

oriented and converses 5

disoriented and converses 4

inappropriate words 3

incomprehensible sounds 2

no response 1

E + M + V = 3 to 15

y 90% less than or equal to 8 are in comay Greater than or equal to 9 not in comay 8 is the critical scorey Less than or equal to 8 at 6 hours - 50% diey 9-11 = moderate severityy Greater than or equal to 12 = minor injury

Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not utteringunderstandable words.