What is the Glasgow Coma Scale?

The Glasgow Coma Scale, or GCS, is a system that scores how conscious you are. It does so by assigning numbered scores for how awake a patient is, the level of awareness, and how he responds to simple instructions.

The GCS is much more widely used throughout medicine today. It's the most commonly used scale for measuring decreases in consciousness, including coma.

What is consciousness?

Consciousness has three requirements for the medical context. To be conscious, you have to be:

• Aware: This includes whether or not you can wake up by voice or touch. That's what makes a coma different from just being asleep.
• Alert: This is how responsive you are to other people talking to you and if you can comprehend what is happening around you in the immediate vicinity.
• Oriented: Know who you are, where you are, what day it is, and every other detail to do with the present.

When is the Glasgow Coma Scale used?

The GCS can be used alongside a neurological exam to assess patients by doctors. It is also helpful for any condition in which you might have a decrease in how conscious you are. That includes conditions that are related to injury, such as concussions and traumatic brain injuries.

Low blood sugar (hypoglycemia), poisoning or after a seizure are also conditions that the scale can help with.

What does the Glasgow Coma Scale measure?

During a neurological assessment, any impairments in the functional ability of the primary two branches of the nervous system are assessed. These are the:

• Central nervous system: This system consists of the cerebrum, brainstem and optic nerves, which connect the brain to the retarders existing at the rear of the eyes.
• Peripheral nervous system: This includes all the nervous tissues not classified as central nervous system tissues.

The Glasgow Coma Scale consists of three relevant categories for neurological examination. Most of these pertain to the brain and some can even include the spinal cord and nerves present in the rest of the body:

• Eye response: This refers to the alertness of the individual.
• Motor response: This relates to the level of brain control of muscles and whether there are any problems increasing connections with the body from the brain.
• Verbal response: The purpose of this component is to assess celebration, memory, focus, and orientation, among others.

How does the Glasgow Coma Scale work?

A doctor calculates your Glasgow Coma Scale score by adding the scores of the three categories of GCS. In evaluating the three categories, a doctor tests each in multiple ways. For example, to test your verbal response, they will ask you several questions, like what day of the week, date, or city you are in currently.

One of the best applications of the GCS is to monitor the changes in your level of consciousness. Doctors will often repeat a neurological exam regularly to check for and document any changes in your GCS score.

The scoring rules for the categories are as follows:

• Eye response: This is essentially all about how alert you are. If you are unconscious, it checks the degree of unconsciousness by testing reflex responses to pressure. Pressure here means something like a pinch or a poke. It should only be enough to cause minor, momentary discomfort but not injury.

Eye response score	Score meaning
1	You can open your eyes and keep them open on your own.
2	You do not open your eyes unless someone tells you to do so. Your eyes remain closed otherwise.
3	Your eyes only open when pressure is applied to them.
4	Your eyes don’t open for any reason.

• Verbal response: This is checked by your doctor, who asks questions to test your memory, thinking ability as well as awareness of the world around you. This can also be used to see whether problems in the brain or nerves affect the control of your face and mouth.

Verbal response score	Score meaning
1	You're oriented. You can correctly answer questions about who you are, where you're at, the day or year, etc.
2	You are confused. While you can respond to questions, your responses belie an understanding of what has occurred.
3	You can talk and others can understand your words, but your responses to questions do not make sense.
4	You can’t talk and can only make sounds or noises.
5	You can't speak or make sounds.

• Motor response: This section can also detect connection problems with your nerves, spinal cord, and brain. It may also assess your brain's ability to control muscle movement and how you could understand and follow a given instruction.

Motor (movement) response score	Score meaning
1	You follow instructions on how and when to move.
2	You deliberately move away from something that is pressing on you.
3	You move away from something pressing on you, only as a reflex.
4	You flex muscles (pull in) in response to pressure.
5	You extend muscles (stretch out) in response to pressure.
6	You do not move in response to pressure.

What type of results do you get, and what do the results mean?

The highest GCS score that can be obtained is 15 while the most minimal on the other hand is 3. Achieving a score of 15 indicates that the person is fully conscious, alert, and responsive and has no cognitive or memory impairment issues. Usually, if the score goes down to 8 or below, one is said to be in a coma. The lower the score, the more profound the level of coma.

Doctors might further give a patients GCS score in coded letters or numbers Combination. A score of 15 would be represented as E4V5M6. A score of 3 would be represented as E1V1M1.

GCS score ranges for head injuries

When doctors apply GCS, especially in head-related injuries, severe traumas are usually graded within ranges that are scored. The ranges are as follows:

• 13 to 15: Mild traumatic brain injury; also referred to as mTBI, or concussion.
• 9 to 12: Moderate TBI.
• 3 to 8: Severe TBI.

What do I know about my loved one's GCS score?

In general, your family or closest loved ones would tell your doctor about your score(s). Among other things you ought to know about the GCS and how doctors use it include:

• The result of the test is much more complex than a number: The GCS score does not bring forth details about the test results. A lot goes into a neurological exam that goes beyond the number. Though the number is generally easier to understand, it would be best to talk to the provider of your loved one to learn more about your loved one's condition.
• The GCS has limitations: It is not usable in certain scenarios, such as on a ventilator patient or someone who doesn't speak the same language as the health provider. The scale is also of little value in individuals with conditions or injuries that affect body parts or systems the GCS relies on for scoring, like sight or hearing loss.
• Doctors don't just use the GCS to make a prognosis: Doctors often use the GCS to estimate possible outcomes, but it's only one part of what they may include in their consideration. Discuss with your doctor what the score means and what it might mean in the long term.

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