Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a traditional, well known and widely used scoring system used to measure and evaluate the level of consciousness of a person who has sustained a traumatic brain injury (TBI). It is one of several scales that are utilized for essentially the same three purposes: to evaluate coma for rapid hospital assessment and triage, evaluate disease severity and for the prognosis of morbidity and mortality.
There are several factors considered in differentiating the coma scales from each other including, ease of use and inter-rater reliability. “Inter-rater reliability” refers to the ability to quantify the degree of agreement between two or more observers or “raters” about a set of subjects. Here, the set of subjects are persons who have sustained traumatic brain injuries. In turn, this relates to whether a given coma scale administered by multiple people will produce the same or similar results. Other factors of inter-rater reliability include reproducibility of results and predictive value as to outcomes.
The GCS records the initial and subsequent level of consciousness of a person after a brain injury. It is frequently used at the site of such an injury, e.g., accident scene, in emergency rooms and in intensive care units. It must be utilized by trained staff in order to realize its full evaluative and predictive potential.
GCS scoring is a numerical evaluation based on a score between three and fifteen (3–15). It consists of three parameters: eye response, verbal response and motor response. In turn, the parameters are individually scored and the scores are totaled. The parameters are as follows:
• Eye Response: four scorings are possible:
1. No eye opening
2. Eye opening in response to pain
3. Eye opening to verbal command
4. Eyes open spontaneously
• Verbal Response: five scorings are possible:
1. No verbal response
2. Incomprehensible sounds
3. Inappropriate words
4. Confused
5. Orientated
• Motor Response: six scorings are possible:
1. No motor response
2. Extension to pain. This is sometimes called “decerebrate posture.” It can be typified by rigidity, arms and legs held straight out, toes pointed downward and the head and neck arched backward.
3. Flexion to pain. This can include what is sometimes called “decorticate posture” which is evidenced by rigidity, clenched fists, legs held straight out and arms bent inward toward the body with the twists and fingers bent and held on the chest
4. Withdrawal from pain
5. Localizing pain
6. Obeys commands
A score of 13 or higher on the GCS is considered to be indicative of a mild brain injury, a score of 9–12 typically indicates a moderate injury and 8 or less is deemed to indicate a severe brain injury. A score of 11 must be broken down into its component parts in order to get a true evaluation.
Although the GCS remains a commonly used and reliable measure, another, similar but expanded evaluation is gaining interest, at least in the setting of intensive care unit. The Full Outline of UnResponsiveness (FOUR) score, ranges from zero to sixteen (0–16). It consists of four components: eye response, motor response, brain stem reflexes and respiration patterns. Studies of FOUR were promising in that it was found to be a good predictor of the prognosis of critically ill persons, including those who had undergone intubation. The staff at NeuLife use and have a keen of the Glasgow Coma Scale and well as other reliable evaluation tools.
NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so that he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve, for all of its clients, maximized, sustained outcomes that exceed the expectations of all persons served.
NeuLife, in Mount Dora, Florida, is a fully accessible specialized residential post-acute program providing superior care and specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.
2725 Robie Avenue
Mount Dora, Florida 32757
Call: 800-626-3878
Email: [email protected]
Visit: NeuLifeRehab.com
