The worldrenowned glasgow coma scale gcs which is used by medics around the globe to record the conscious state of a person is celebrating its 40th anniversary this july. Glasgow coma scale seems to probably be very well correlated with asking for peoples subjective opinions about whether someone is in a coma or not and if so how deep the coma is. Ultimately, the three values for eye opening, verbal, and motor responses were combined into a single score ranging from 315. Gcs terms of 1974 and 2014 since the glasgow coma scale was developed 40 years ago it has been indicator of level of consciousness term used accepted. It is numerical rating system, originally used for measuring conscious state following traumatic brain injury, which has become a widely used and recognised. The extended glasgow coma scale and mtbi michael j. Teasdale g et al 1979 adding up the glasgow coma score. The experience gained since it was first described in 1974 has advanced the assessment of the scale through the development of a modern structured approach with improved accuracy, reliability, and communication in its use. Since the glasgow coma scale was developed 40 years ago it has been accepted throughout the world as a method for assessing impaired consciousness. An audit was performed and insufficient documentation was confirmed. Consequently the pediatric glasgow coma scale, a separate yet closely related scale, was developed for assessing younger children.
The glasgow coma scale is an objective method of evaluating a trauma patients neurologic status. Score the best level of response seen for each component. The glasgow coma scale gcs is a neurological scale which aims to give a reliable and objective way of recording the state of a persons consciousness for initial as well as subsequent assessment. Ebook or pdf edited book email encyclopedia article govt. Total glasgow coma scale tgcs scores range from 3 to 15 with. Since 1974, the glasgow coma scale has provided a practical. A person is assessed against the criteria of the scale, and the resulting points give a persons score between 3 indicating deep unconsciousness and either 14 original scale or 15 more widely. Glasgow coma scale explained rhea mehta, gp trainee1, krishna chinthapalli, consultant neurologist2 1east surrey hospital, redhill, uk. Mclernon s 2014 the glasgow coma scale 40 years on.
Patients with brain injuries are assessed using the glasgow coma scale gcs. The glasgow coma scale gcs is an international tool used to measure the level of consciousness for traumatically injured patients. The glasgow coma scale gcs was introduced 40 years ago and has received worldwide acceptance. Abstract the glasgow coma scale gcs was introduced 40 years ago and. The extended glasgow outcome scale gose is a hierarchical scale in which the patients overall rating score is based on the lowest outcome category indicated by. As discussed in my first post in this series, the original glasgow coma scale gcs was described in 1974. Although the term glasgow coma scale alone yielded 399 hits in scopus, over 7600 in web of knowledge and 164 in cinahl, however, when searching glasgow coma scale with terms such as painful stimuli the yield was very small. The glasgow coma scalescore gcs estimates coma severity based on eye 4, verbal 5, and motor 6 criteria.
The scale assesses a patients best eye, verbal, and motor responsiveness. Steyerberg, daan nieboer, walter mauritz, martin rusnak, hester f. We compared the performance of the glasgow coma scale gcs with full outline of unresponsiveness four scale as an alternative method in the identification of clinically relevant outcomes in traumatic brain injury. It is the dedication of healthcare workers that will lead us through this crisis. The glasgow coma scale gcs 3,4 is a widelyused instrument to assess consciousness at the site of injury, in emergency departments, and in hospitals to monitor progress or deterioration during treatment.
Neurological assessment is an essential element of early warning scores used to recognize critically ill patients. The glasgow coma scale provides a practical method for assessment of impairment of conscious level in response to defined stimuli. The extended glasgow coma scale and mtbi slater vecchio. These typically have been derived either by shortening components of. Keep in mind that there is nothing mild about a brain injurythe term mild brain injury is used to describe a level of neurological injury.
Glasgow coma scale the glasgow coma scale provides a score in the range 315. The glasgow coma scale was described in 1974 by graham teasdale and bryan jennett as a way to communicate about the level of consciousness of patients. The use of glasgow coma scale in injury assessment. The scale was designed to be easy to use in clinical practice in general and specialist units and to replace previous illdefined and inconsistent methods. In the acute stage, changes in conscious level provide the best indication of the development of complications such as intracranial haematoma whilst the depth of coma and its duration indicate the degree of. The total score is the sum of the scores in three categories. Lack of standardization in the use of the glasgow coma. An educational plan was developed and implemented to improve. Background the gcs was developed at the university of glasgows institute of neurological sciences.
Concerns have been expressed with regard to reliability and consistency of assessments. Glasgow coma scale gcs is the most commonly used tool in assessing. The glasgow coma scale and evidence informed practice. Comparison of field and admission assessment marek majdan, ewout w. Do it this way rate for factors interfering with communication, ability to respond and other injuries eye opening, content of speech and movements of right and left sides sound. The scale, however, was never intended to be used as guide to outcome teasdale et al.
The authors critically appraised the current state of gcs scoring. Gcs 40 glasgow coma scale updates standardize stimulation response full template. December, 2001 introduction in cases where a lawyer is attempting to prove that a plaintiff has suffered a mild traumatic brain injury mtbi following a motor vehicle accident, it is likely that the plaintiff has experienced a brief period of post traumatic. A glasgow coma scale gcs assessment should be conducted on every patient.
Neil d a stewart lynne is a young woman who once dreamed of being an artist, but whose promotion to supervisor at a callcentre in glasgow is sucking the soul out of her. Pediatric glasgow coma scale chart glasgow coma scale made easy full template. The glasgow structured approach to assessment of the glasgow coma scale. The gcs rates eye, motor and verbal responses to assess the level of. The gos is helpful in determining next steps in the individuals care, but is not useful in detecting small, gradual improvements. Glasgow coma scale eye opening response spontaneousopen with blinking at baseline 4 points to verbal stimuli, command, speech 3 points to pain only not applied to face 2 points no response 1 point verbal response. Glasgow coma scale an overview sciencedirect topics. However, gcs is often used as part of the decision tool to define the population transferred directly to a major. How to improve and enhance documentation journal of trauma nursing.
This article addresses the variations in technique that have developed since the scale was published. In addition, the score has been incorporated into many trauma and. Glasgow coma scale eye opening response spontaneousopen with blinking at baseline 4 points to verbal stimuli, command, speech 3 points. The glasgow coma scale gcs has been the gold standard of neurologic assessment for trauma patients since its development by jennett and teasdale in the early 1970s. The tbi is graded into mild, moderate, severe, and vegetative according to the glasgow coma scale gcs. Webbased survey results collected may 27, 2014, 446 73. Glasgow coma scale is unreliable for the prediction of. The modified gcs was developed to be used in a repeated manner in the inpatient setting to assess and communicate changes in a patients mental status and to measure the. Assessment of physicians knowledge of glasgow coma score. Glasgow coma scale motor score and pupillary reaction to predict sixmonth mortality in patients with traumatic brain injury. Pubmed and isi web of knowledge sm were searched using specific keywords.
In 1974, the glasgow coma scale gcs was first validated in adult mean age, 33 years patients using repeated measurements during the course of a week. Middleton pm 2012 practical use of the glasgow coma scale. The presenting gcs in elderly patients with traumatic brain injury tbi may not reflect the severity of injury as accurately as it does in the younger patient population. The gcs rates eye, motor, and verbal responses to assess the level of consciousness. Teasdale g et al 2014 the glasgow coma scale at 40 years. Glasgow coma scale explained rhea mehta, gp trainee1, krishna chinthapalli. When i picked this up in the bookstore, i was expecting more of a romantic element, but i didnt get it and in hindsight im glad neil d.
Objectives and background elderly patients comprise an everincreasing proportion of major trauma patients. The gcs is the most common and accepted 15point scale used to measure coma and impaired consciousness after tbi. A comparison of the glasgow coma scale score with full. The glasgow coma scale is an integral part of clinical practice and research across the world. The modified glasgow coma scale modified gcs is a 15point scale that has been widely adopted, including by the original unit in glasgow, as opposed to the 14point scale. This standardised clinical scoring system allowed clinicians to assess and communicate neurological change and quantification of consciousness. Review of the scale s composition and its application structured approach to assessment forty years after its initial implementation, the glasgow coma scale has been updated to address variations in technique that have developed over time forty years on. This article addresses the variations in technique that have developed since the scale was. Be warned the glasgow coma scale is neither an uplifting nor inspirational read. It was originally intended to be a chart of all three components, trended over time.
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