The Glasgow Coma Scale – What Is It For? Determining the level of consciousness of the patient

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The Glasgow Coma Scale is a scale that allows you to determine the level of consciousness of a patient and is used in medicine, especially in patients with head injury. It is used both in emergency medicine and to assess changes in the patient’s level of consciousness during treatment.

What are the levels of the Glasgow scale and how are they measured?

The Glasgow Coma Scale evaluates several parameters. The first is to open your eyes. They are scored as follows:

  1. spontaneous eye opening – 4 points,
  2. eye opening on command – 3 points,
  3. opening the eyes to pain stimuli – 2 points,
  4. the patient does not open his eyes – 1 point.

Another parameter is verbal contact. It is assessed as follows:

  1. the patient responds logically, knows where he is, who he is (what is his name) and what is the date – 5 points,
  2. the patient responds in a confused manner, is confused – 4 points,
  3. the patient gives inadequate answers, off-topic or shouts – 3 points,
  4. the patient makes incomprehensible sounds, moans – 2 points,
  5. no reaction – 1 point.

The Glasgow scale also assesses the patient’s motor reaction:

  1. the patient follows motor verbal or sign language commands – 6 points,
  2. the patient performs targeted movements, locates the pain stimulus – 5 points,
  3. there is a defensive reaction to pain, withdrawal, the patient tries to remove the pain stimulus – 4 points,
  4. there is a pathological flexion reaction and debarking, i.e. addiction of the arms, flexion in the elbow joints and the hand, hyperextension in the joints of the lower limbs – 3 points,
  5. there is a pathological reaction of extension and brain injury, i.e. abduction and rotation of the arms inwards, extension of the elbows and conversion of the forearms with flexion of the hand joints, hyperextension in the joints of the lower limbs, inversion of the foot – 2 points,
  6. no reaction – 1 point.

The points obtained for each of the three assessed reactions are added together. The total sum of points is from 3 to 15 – on this basis, the patient’s condition is assessed according to the Glasgow scale. However, it should be taken into account how many points were obtained in each of the tested reactions. The Glasgow Coma Scale allows you to assess the patient’s consciousness and its disturbances as follows:

  1. 13-15 GCS – mild consciousness disorders,
  2. 9-12 GCS – moderate disturbance of consciousness,
  3. 6-8 GCS – unconsciousness,
  4. 5 GCS – debarking,
  5. 4 GCS sleeplessness,
  6. 3 GCS – brain death.

However, in some situations it is difficult to assess the patient’s condition and place it on the Glasgow scale. This happens, for example, in the case of intubation, when the conscious patient does not tolerate the endotracheal tube and the GCS result is an indication for intubation, and paresis and paralysis when the patient is not moving. When the emergency team is confronted with a head injury patient, the loss of at least one Glasgow GCS point is an indication for a head CT scan.

Glasgow Scale for Children

For children under 4 years of age, the Glasgow Pediatric Scale is used. Like the Glasgow Coma Scale for adults, the Pediatric Glasgow Scale has three items. Visual, verbal and motor responses are assessed.

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