Glasgow Coma Scale (GCS): How is a score assessed?
The GCS, or Glasgow Coma Scale, was described in 1974 by Graham Teasdale and Bryan Jennett (Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-4.) as a method of assigning a score, or level, of consciousness of patients with an acute brain injury
GCS score, the parameters taken into account:
Scale scores guide initial decision-making and monitor trends in reactivity that are important in signalling the need for further action.
Eyes
- Spontaneous
- To sound
- To pressure
- None
Verbal Activity
- Coordinated
- Confused
- Single Words
- Sounds
- None
Motor Activity
- Obeys commands
- Localised
- Normal flexion
- Abnormal flexion
- Extension
- None
Development of the GCS and Glasgow Coma Scale scores
Comparison of assessments using different methods on a large number of patients in the Glasgow neurosurgical unit highlighted the merits of a multidimensional approach to assessment.
A short list of terms capable of being clearly defined and ranked in order of importance was refined through inter-observer agreement studies.
The refinement took into account contributions from junior doctors and nurses as well as experienced international colleagues.
The goal in developing the scale was for it to be widely acceptable and to complement, not replace, the assessment of other neurological functions.
Adoption and dissemination of the Glasgow Coma Scale
The simplicity and ease of transmission of the scale has been welcomed in departments dealing with patients with acute brain injury from trauma and other causes.
The display of results on a specially designed chart facilitated the identification of the patient’s clinical changes.
The nursing staff quickly appreciated the clarity in capturing important trends in the patient’s condition.
With the rapid expansion in the number of intensive care units, the arrival of computerised tomography (CT) and the spread of brain monitoring, interest in the management of the head injury patient grew.
Research required standardised methods to report initial severity and outcome.
The advantage of a shared score: the GCS then became increasingly used as a common ‘language’ internationally to communicate and discuss the merits of different advances in clinical practice and to apply them to patient care
The use of the Scale was promoted in 1980, when it was recommended for all types of injuries in the first edition of Advanced Trauma and Life Support, and again in 1988, when the World Federation of Neurosurgical Societies (WFNS) used it in its scale for classifying patients with subarachnoid haemorrhage.
The scale has progressively occupied a central role in clinical guidelines and has become an integral component of scoring systems for victims of trauma or critical illness.
Forty years after the original description, a review published in The Lancet Neurology (2014; 13: 844-54) reported that the GCS was used by neurosurgeons and other disciplines in more than 80 countries worldwide and had been translated into the national language in 74%.
The review also noted a continued increase in the use of the Scale in research reports, making it the most frequently cited document in clinical neurosurgery.
The score: indices derived from the Glasgow Coma Scale (GCS score)
The Glasgow Coma Scale score (GCS score) was developed to combine the results of the three components of the Scale into a single index (Acta Neurosurgica. 1979; 1: Suppl 28: 13-16).
Its possible values range from 3 to 15.
Although it has lost some of the detail and discrimination conveyed by the full scale, it has become popular as a simple summary measure in communication in clinical practice and in the analysis and classification of results in patient groups.
The Glasgow Coma Scale – Pupils score (GCS-P) was described in 2018 in response to a desire for a single index combining the Coma scale with pupillary reactivity as a reflection of brainstem function (Journal of Neurosurgery 2018;128 : 1612-1620).
Possible values range from 1 to 15, reflecting an extended range of severity, and may be particularly useful in relation to prognosis.
Bibliographic references:
Teasdale G, Jennett B: Valutazione del coma e della compromissione della coscienza: Una scala pratica. Lancet 304:81-84, 1974
Teasdale G, Galbraith S, Clarke K: Compromissione acuta delle funzioni cerebrali-2. Schema di registrazione dell’osservazione. Nurs Times 71:972-3e, 1975
Teasdale G, Jennett B: Valutazione e prognosi del coma dopo trauma cranico. Acta Neurochir (Wien) :1976
Teasdale G, Knill-Jones R, Van Der Sande J: Variabilità dell’osservatore nella valutazione della perdita di coscienza e del coma. J Neurol Neurosurg Psychiatry:1978
Teasdale G, Murray G, Parker L, Jennett B: Sommare il Glasgow Coma Score. Acta Neurochir Suppl (Wien) 28:13-6, 1979
Middleton PM: Uso pratico della Glasgow Coma Scale; una revisione narrativa completa della metodologia GCS. Australas Emerg Nurs J:2012
Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G: La Glasgow Coma Scale a 40 anni: Resistere alla prova del tempo. Lancet Neurol 13:844-854, 2014
Teasdale Graham, Allan D, Brennan P, McElhinney E, Mckinnon L: Quarant’anni dopo: aggiornamento della Glasgow Coma Scale. Nurs Times 110:12-16, 2014
Ponce FA, Lozano AM: Erratum: Opere altamente citate in neurochirurgia. Parte II: i classici delle citazioni. J Neurosurg:2014
Reith FCM, Brennan PM, Maas AIR, Teasdale GM: Mancanza di standardizzazione nell’uso della scala del coma di Glasgow: Risultati di indagini internazionali. J Neurotrauma 33:2016
Reith FCM, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AIR: Effetti differenziali del punteggio della Glasgow Coma Scale e dei suoi componenti: Un’analisi di 54.069 pazienti con lesioni cerebrali traumatiche. Lesioni:2017
Reith FC, Synnot A, van den Brande R, Gruen RL, Maas AI: Fattori che influenzano l’affidabilità della Glasgow Coma Scale: A Systematic Review. Neurochirurgia:2017
Reith FCM, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AIR: Effetti differenziali del punteggio della Glasgow Coma Scale e dei suoi componenti: Un’analisi di 54.069 pazienti con lesioni cerebrali traumatiche. Lesioni:2017
Reith FC, Synnot A, van den Brande R, Gruen RL, Maas AI: Fattori che influenzano l’affidabilità della Glasgow Coma Scale: A Systematic Review. Neurosurgery:2017
Brennan PM, Murray GD, Teasdale GM: Semplificare l’uso delle informazioni prognostiche nelle lesioni cerebrali traumatiche. Parte 1: Il punteggio GCS-Pupils: un indice esteso di gravità clinica. J Neurosurg:2018
Murray GD, Brennan PM, Teasdale GM: Semplificare l’uso delle informazioni prognostiche nelle lesioni cerebrali traumatiche. Parte 2: Presentazione grafica delle probabilità. J Neurosurg:2018
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