2. Glasgow Coma Scale
• Published in 1974 by Jennett and Teasdale
• The Glasgow Coma Scale provides a practical
method for assessment of impairment of
conscious level in response to defined stimuli.
• It aims to determine the severity of brain
dysfunction
3. • The findings using the scale guide initial
decision making and monitor trends in
responsiveness that are important in signalling
the need for new actions.
4. • Patient assessment will result in a score
between three (3); no response and fifteen
(15); fully alert and responsive
• The score out of 15 is derived from the three
tests on eye opening, verbal response and
motor response. Alongside this, pupil
response, neurological limb response and vital
signs are also recorded.
5. Eye Response
SCORE DESCRIPTION
4 Eyes open spontaneously
3 Eyes open to speech
2 Eyes open in response to pain only
1 Eys do not open to verbal or pain
stimuli
*** ‘C’ is recorded to patients unable to open their eyes due to
trauma/ swelling
6. Verbal Response
score Description
5 Oriented; must be able to tell you their full name, the
place in which they are and the date. If the patient
doesn't know any of these, assume they are confused.
4 Confused; not able to answer orientation questions
3 Inappropriate words; swearing, aggression, unrelated
words being asked
2 Incomprehensible sounds
1 No verbal response
*** ‘D’ is marked for patients who are dysphasic (unable to
speak coherently
‘T’ is marked for patients with tracheostomy
7. Motor Response
score Description
6 Obeys command. Patient can perform two different
movement; primitive reflexes should not be tested.
5 Localizes to central pain. Patient does not respond to
verbal stimulus but purposely moves an arm to remove
the cause of central stimulus
4 Normal flexion. The patient flexes or bends the arm
towards the source of pain but fails to locate the source
of pain (no wrist rotation)
3 Abnormal flexion to pain
2 Extension to pain
1 no response to stimuli
8.
9.
10. • Brain injury is often classified as
– Severe ( GCS ≤8)
– Moderate ( GCS 9-12).
– Mild (GCS ≥ 13)
12. • Can we always evaluate all components of GCS?
• The answer is no. And in these situation an NT,
meaning Non-testable indicates that the
parameter can not be evaluated.
• There are several factors that can interfere with
the patient’s level of consciousness, leading to an
inaccurate GCS score; and some of them unable
the evaluation of the component.
13. • Pre-existing factors (language or cultural
barriers; intellectual or neurological deficit;
hearing loss or speech impediment);
• Effects of current treatment (physical factors
such as intubation or tracheostomy; and
pharmacological factor such as sedation or
paralysis);
• Effects of other injuries or lesions (such as
orbital/cranial fracture; dysphasia or
hemiplegia; and spinal cord injury).
14. • If a component is Not Testable, DO NOT report
a total score for GCS, because the score will be
low, inaccurate and reflecting a wrong idea
that the patient is more unwell than they
actually are.
