Case 4: Maisie

Glasgow coma scale

Background information on the Glasgow coma scale (GCS)

The Glasgow coma scale (GCS) 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. Glasgow Coma Scale (GCS)

Three types of response are measured:

• Best motor response – maximum score of 6
• Best verbal response – maximum score of 5
• Eye opening – maximum score of 4

The lowest score for each category is 1, therefore the lowest score possible is 3 (= no response to pain + no verbalisation + no eye opening). A healthy person will score 15/15.

• A patient with a GCS less than or equal to 8 requires the early involvement of an anaesthetist or critical care physician to provide appropriate airway management.
• Reduction in motor score by one or an overall deterioration of two is significant and should be reported
• Differences in GCS scores of two or more have been reported on the same patients by different practitioners. This reinforces that clinical decisions should not be solely based upon GCS but be used as a component of neurological function.

Glasgow coma scale:

Score
Eye opening	Spontaneous – Open before stimulus(+4) To Sound – After spoken request (+3) To Pressure – After fingertip stimulus (+2) None – No opening at any time, no interfering factor (+1) Closed by local factor – (NT)
Verbal response	Oriented – Correctly gives name, place, and date (+5) Confused – Not orientated but communicates coherently (+4) Words – Intelligible single words (+3) Sounds – Only moan/groans (+2) None – No audible response, no interfering factor (+1) Non-testable – Factor interfering with communication (NT)
Motor response	Obeys Commands – 2-part request (+6) Localising – Brings hand above clavicle to stimulus on head/neck (+5) Normal Flexion – Bends arm at elbow rapidly but features not predominantly abnormal (+4) Abnormal flexion – Bends arm at elbow, features clearly predominantly abnormal (+3) Extension – Extends arm at elbow (+2) None – No movement in arms/legs, no interfering factor (+1) Non-testable – Paralysed or other limiting factor (NT)
Maximum score	15

 

GCS assessment method updates-
Check: To check for any factors that might interfere with the assessment, for example stroke patients may have hemiparesis, dysphasia and hearing loss.

Observe: To see for spontaneous patient actions (e.g. eye opening).

Stimulate: Once it is decided that there is no spontaneous response then to stimulate and check for responses.

Rate: After the stimulation for various parameters the score is recorded and totalled to arrive at the GCS score. If the initial check identifies cannot be assessed appropriately, the rating is classified as “not testable” and recorded NT.

Health professionals use the aforementioned scale for the best eye opening response, the best motor response, and the best verbal response. Consideration is made for those with tracheostomy and endotracheal breathing tubes.

 

 

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Page last reviewed: 03 Mar 2021