View Full Version : Glasgow Coma Scale and Extended Glasgow Outcome Scale

Wed 9th March '16, 2:06pm
Glasgow Coma Scale


Does not open eyes
Opens eyes in response to painful stimuli (https://en.wikipedia.org/wiki/Pain_stimulus)
Opens eyes in response to voice
Opens eyes spontaneously

Makes no sounds
Incomprehensible sounds
Utters inappropriate words
Confused, disoriented
Oriented, converses normally

Makes no movements
Extension to painful stimuli (decerebrate response (https://en.wikipedia.org/wiki/Abnormal_posturing#Decerebrate))
Abnormal flexion to painful stimuli (decorticate response (https://en.wikipedia.org/wiki/Abnormal_posturing#Decorticate))
Flexion / Withdrawal to painful stimuli
Localizes painful stimuli
Obeys commands

Note that a motor response in any limb is acceptable.[2] (https://en.wikipedia.org/wiki/Glasgow_Coma_Scale#cite_note-2) The scale is composed of three tests: eye (https://en.wikipedia.org/wiki/Visual_perception), verbal (https://en.wikipedia.org/wiki/Speech_communication) and motor (https://en.wikipedia.org/wiki/Motor_skill) responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma (https://en.wikipedia.org/wiki/Coma) or death (https://en.wikipedia.org/wiki/Death)), while the highest is 15 (fully awake person).
Eye response (E)[edit (https://en.wikipedia.org/w/index.php?title=Glasgow_Coma_Scale&action=edit&section=2)]There are four grades starting with the most severe:

No eye opening
Eye opening in response to pain stimulus (https://en.wikipedia.org/wiki/Pain_stimulus). (a peripheral pain stimulus, such as squeezing the lunula (https://en.wikipedia.org/wiki/Lunula_(anatomy)) area of the patient's fingernail (https://en.wikipedia.org/wiki/Nail_(anatomy)) is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).[3] (https://en.wikipedia.org/wiki/Glasgow_Coma_Scale#cite_note-3)
Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
Eyes opening spontaneously

Verbal response (V)[edit (https://en.wikipedia.org/w/index.php?title=Glasgow_Coma_Scale&action=edit&section=3)]There are five grades starting with the most severe:

No verbal response
Incomprehensible sounds. (Moaning but no words.)
Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
Oriented (https://en.wikipedia.org/wiki/Orientation_(mental)). (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Motor response (M)[edit (https://en.wikipedia.org/w/index.php?title=Glasgow_Coma_Scale&action=edit&section=4)]There are six grades:

No motor response
Decerebrate posturing (https://en.wikipedia.org/wiki/Abnormal_posturing#Decerebrate) accentuated by pain (extensor response: adduction (https://en.wikipedia.org/wiki/Adduction) of arm, internal rotation of shoulder, pronation (https://en.wikipedia.org/wiki/Pronation) of forearm and extension at elbow, flexion (https://en.wikipedia.org/wiki/Flexion#Flexion_and_extension) of wrist and fingers, leg extension, plantarflexion (https://en.wikipedia.org/wiki/Anatomical_terms_of_motion#Flexion_and_extension_o f_the_foot) of foot)
Decorticate posturing (https://en.wikipedia.org/wiki/Abnormal_posturing#Decorticate) accentuated by pain (flexor response: internal rotation of shoulder, flexion (https://en.wikipedia.org/wiki/Flexion) of forearm and wrist with clenched fist, leg extension, plantarflexion (https://en.wikipedia.org/wiki/Anatomical_terms_of_motion#Flexion_and_extension_o f_the_foot) of foot)
Withdrawal from pain (Absence of abnormal posturing; unable to lift hand past chin with supraorbital (https://en.wikipedia.org/wiki/Supraorbital) pain but does pull away when nailbed is pinched)
Localizes to pain (Purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supraorbital (https://en.wikipedia.org/wiki/Supraorbital) pressure applied.)
Obeys commands (The patient does simple things as asked.)

Generally, brain injury is classified as:

Severe, with GCS < 8–9
Moderate, GCS 8 or 9–12 (controversial)[4] (https://en.wikipedia.org/wiki/Glasgow_Coma_Scale#cite_note-4)
Minor, GCS ≥ 13.

Wed 9th March '16, 2:08pm
1 = Dead

2 = Vegetative State
Condition of unawareness with only reflex responses but with periods of spontaneous eye opening.

3 = Low Severe Disability
4 = Upper Severe Disability
Patient who is dependent for daily support for mental or physical disability, usually a combination of both. If the patient can be left alone for more than 8h at home it is upper level of SD, if not then it is low level of SD.

5 = Low Moderate Disability
6 = Upper Moderate Disability
Patients have some disability such as aphasia, hemiparesis or epilepsy and/or deficits of memory or personality but are able to look after themselves. They are independent at home but dependent outside. If they are able to return to work even with special arrangement it is upper level of MD, if not then it is low level of MD.

7 = Low Good Recovery
8 = Upper Good Recovery
Resumption of normal life with the capacity to work even if pre-injury status has not been achieved. Some patients have minor neurological or psychological deficits. If these deficits are not disabling then it is upper level of GR, if disabling then it is lower level of GR.