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The Glasgow Coma Scale (GCS) is a tool used to assess a person’s level of consciousness, developed in the 1970s at the University of Glasgow. It assesses eye response, movement, and verbal response, with scores ranging from 3 (deep unconsciousness) to 15 (fully awake and aware). The Pediatric Coma Scale is used for infants. Injuries and medical interventions can affect accuracy.
The Glasgow Coma Scale (GCS) is a commonly used assessment tool for whether a person has a head injury, is unconscious, or is in a coma. It was developed in the 1970s at the University of Glasgow, hence the name. Two neurology specialists, Graham Teasdale and Bryan Jennet, are credited with its development. It is used extensively in medical facilities around the world, although there are other assessment tools that can also be used to determine level of consciousness.
There are three things that the Glasgow Coma Scale assesses to assess the degree of consciousness and these are eye response, movement and verbal response. Higher scores, with 15 being the highest, indicate a greater level of consciousness, and indeed a fifteen would mean a person was fully awake and aware. A three is the lowest score and suggests extremely deep unconsciousness. Scores in all areas are added together to produce the total score.
In evaluating eye response, people can score up to four. The following ratings apply:
1. Eyes do not open
2. Eyes open if pain is applied
3. Eyes open if the person is addressed
4. Eyes open by themselves
In the motor response on the Glasgow Coma Scale, responses are classified as such:
1. There is no movement
2. The body stretches when painfully stimulated
3. The body shrinks abnormally when painfully stimulated
4. The body normally withdraws in response to pain
5. The body responds normally where pain occurs
6. The person can move and use the body at the request of a doctor “Raise arm, shake fingers”, etc.
Verbal response on the Glasgow Coma Scale is assessed as follows:
1. There is no verbal sound
2. Person makes sounds that cannot be understood
3. The person says things that don’t make sense
4. The person may respond to the conversation but appears confused and doesn’t always respond appropriately
5. Person speaks normally with an adequate conversational response.
It’s easy to see why the Glasgow Coma Scale would be useful for assessing adults and children, but it may not be as useful for assessing pre-speaking infants. There is a Pediatric Coma Scale adapted from the GCS, which can be used alternatively, and is in fact often used when children are injured or are hospitalized to continue to assess well-being.
It’s also not always possible to get a completely accurate score on the GCS due to injuries or things like intubation, where a person has a breathing tube. Facial injuries can affect eye movement, and injuries to the body, especially paralysis, could affect motor response to pain. A person with a breathing tube cannot speak, although if she is fully conscious, she could write responses and show level of consciousness in this way.
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