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Thread: Glasgow Coma Scale and Extended Glasgow Outcome Scale

  1. #1

    Default Glasgow Coma Scale and Extended Glasgow Outcome Scale

    1 2 3 4 5 6
    Eye Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A
    Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
    Motor Makes no movements Extension to painful stimuli (decerebrate response) Abnormal flexion to painful stimuli (decorticate response) Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands


    Note that a motor response in any limb is acceptable.[2] The scale is composed 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 or death), while the highest is 15 (fully awake person).
    Eye response (E)[edit]

    There are four grades starting with the most severe:

    1. No eye opening
    2. Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the patient's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).[3]
    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.)
    4. Eyes opening spontaneously

    Verbal response (V)[edit]

    There are five grades starting with the most severe:

    1. No verbal response
    2. Incomprehensible sounds. (Moaning but no words.)
    3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
    4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
    5. Oriented. (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]

    There are six grades:

    1. No motor response
    2. Decerebrate posturing accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot)
    3. Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot)
    4. Withdrawal from pain (Absence of abnormal posturing; unable to lift hand past chin with supraorbital pain but does pull away when nailbed is pinched)
    5. Localizes to pain (Purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supraorbital pressure applied.)
    6. 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]
    • Minor, GCS ≥ 13.
    Clinical Pharmacy Specialist - Infectious Diseases

  2. #2

    Default Extended Glasgow Outcome Scale

    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.
    Clinical Pharmacy Specialist - Infectious Diseases

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