Glasgow Coma Scale

The Glasgow Coma Scale (also known as Glasgow Coma Score or simply GCS) was first published by Glasgow-based Teasdale & Jennett (1974) to assess head trauma and, importantly, to help keep track of patients' progress over a period of time. The scale is comprised 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) whilst the highest is 15 (fully awake person). The Rancho Scale is used to assess awakening and recovering coma patients.

Best eye response: (E)

1. No eye opening
2. Eye opening to pain
3. Eye opening to speech
4. Eyes opening spontaneously

Best verbal response: (V)

1. No verbal response
2. Incomprehensible sounds
3. Inappropriate words
4. Confused
5. Orientated

Best motor responses: (M)

1. No motor response
2. Extension to pain (decerebrate response)
3. Flexion to pain (decorticate response)
4. Withdraws from pain (pulls part of body away when pinched)
5. Localises pain (pulls examiner's hand away)
6. Obeys commands

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".

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.

Reference

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