NABIS Help Line Glasgow Coma Scale -Text Version

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The Glasgow Coma Scale

The Glasgow Coma Score is the most reliable of the various coma scales currently in use. It also requires only a brief examination of the patient and can therefore be obtained early on by non-professional people, such as paramedics. Because it is easy and quick to determine, it can be repeated frequently. Scoring the patient often and regularly can help make predictions about the outcome. Predictions made on the outcome of the patient are typically very accurate and when they err, they do so on the optimistic side.

The Glasgow Coma Scale was designed to meet a need for a standardized initial evaluation. The scale assesses three components: eye opening, best verbal response, and best motor response. The lower the mark is, the more severe the brain injury. The lowest mark possible is 3. The highest mark possible is 15. As a patient comes out of coma, the mark rises. The scale is as follows:

Motor Response	Example	Score
Commands	Follows simple commands	6
Localizes Pain	Pulls examiner's hand away when pinched	5
Withdraws from Pain	Pulls a part of body away when pinched	4
Abnormal Flexion	Flexes body inappropriately to pain	3
Abnormal Extension	Body becomes rigid in an extended position when examiner pinches him	2
No Response	Has no motor response to pinch	1
Eye-Opening		.
Spontaneous	Opens eyes on own	4
To Voice	Opens eyes when asked to in a loud voice	3
To Pain	Opens eyes when pinched	2
No Response	Does not open eyes	1
Verbal Response (Talking)		.
Orientated	Carries on a conversation correctly and tells examiner where he is, who he is, and the month and year	5
Confused Conversation	Seems confused or disoriented	4
Inappropriate Words	Talks so examiner can understand him but makes no sense	3
Sounds	Makes sounds that examiner cannot understand	2
No Response	Makes no noise	1

A chart that may be helpful to track a patients' progress may look something like this:

DAY	1	2	3	4	5	6	7
Motor Response
Eye Opening
Verbal Response
TOTAL

If the patient is receiving drugs, it may impair use of the scale.

If the patient rises four levels on the Coma Scale within the first 24 hours, this is considered a rapid improvement.

If the patient rises four levels in the Coma Scales in three days, this is considered a moderate improvement.

If the patient rises four levels on the Coma Scale in the first week, this is considered a slow improvement.

Some patients remain on their original coma score, without a change for weeks. This is called a prolonged coma.

Those patients who do not come out of coma may pass into a vegetative state. This state is often characterized by periods of the day during which the person's eyes are open, giving the appearance of wakefulness, but shows no signs that he or she is aware of the environment around him or her. The person is awake, but not aware.

References:
Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

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