The Glasgow Coma Scale
When reading articles or correspondence on Traumatic Brain Injury, have you ever wondered what The Glasgow Coma Scale really means? The Glasgow Coma Scale relates a patient's ability to open his/her eyes, respond to verbal commands and responses. Each level of response indicates the degree of brain activity. It is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury. It is used primarily because it is simple, has a relatively high degree of observer reliability and because it correlates well with outcome following severe brain injury. The score represents the sum of all scores in each category. There are some limitations to its use. If the patient has an endotracheal tube in place, they cannot talk. For this reason, many prefer to document the score by its individual components; so a patient with a Glasgow Coma Score of 15 would be documented as follows: E4 V5 M6. An intubated patient would be scored as E4 Vintubated M6. Of these individual factors, the best motor response is probably the most significant. Other factors which alter the patients’ level of consciousness interfere with the scale's ability to accurately reflect the severity of a traumatic brain injury. Such as: shock, hypoxemia, drug use and alcohol intoxication. Obviously, a patient with a spinal cord injury will make the motor scale invalid, and severe orbital trauma may make eye opening impossible to assess. The GCS also has limited utility in children, particularly those less than 36 months.
