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Glasgow Coma Scale or GCS Is A: Best Eye Response (E)

The Glasgow Coma Scale (GCS) aims to provide an objective way to assess a person's conscious state. It evaluates eye, verbal, and motor responses on a scale of 3 to 15, with lower scores indicating worse neurological function. The GCS was created in 1974 and is widely used to evaluate brain injury severity and monitor intensive care patients. It assesses responses to stimuli including opening eyes, verbal sounds, and limb movements. The individual scores are summed to determine the overall GCS, with severe brain injury indicated by a score of 8 or lower.

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Eunice Kristia Esteleydes
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145 views

Glasgow Coma Scale or GCS Is A: Best Eye Response (E)

The Glasgow Coma Scale (GCS) aims to provide an objective way to assess a person's conscious state. It evaluates eye, verbal, and motor responses on a scale of 3 to 15, with lower scores indicating worse neurological function. The GCS was created in 1974 and is widely used to evaluate brain injury severity and monitor intensive care patients. It assesses responses to stimuli including opening eyes, verbal sounds, and limb movements. The individual scores are summed to determine the overall GCS, with severe brain injury indicated by a score of 8 or lower.

Uploaded by

Eunice Kristia Esteleydes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious

state of a person for


initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score
between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).

GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, and doctors as being
applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow.

GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system. A
similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients.

Elements of the scale

Glasgow Coma Scale


1 2 3 4 5 6
Does not open Opens eyes in response to Opens eyes in response to Opens eyes
Eyes N/A N/A
eyes painful stimuli voice spontaneously
Oriented,
Makes no
Verbal Incomprehensible sounds Utters inappropriate words Confused, disoriented converses N/A
sounds
normally
Makes no Extension to painful stimuli Abnormal flexion to painful Flexion / Withdrawal to Localizes painful Obeys
Motor
movements (decerebrate response) stimuli (decorticate response) painful stimuli stimuli commands

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest
possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Best eye response (E)

There are 4 grades starting with the most severe:

1. No eye opening
2. Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response,
supraorbital and sternal pressure or rub may be used.)
3. Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
4. Eyes opening spontaneously

Best verbal response (V)

There are 5 grades starting with the most severe:

1. No verbal response
2. Incomprehensible sounds. (Moaning but no words.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
5. Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why,
the year, month, etc.)] Best motor response (M)

There are 6 grades starting with the most severe:

1. No motor response
2. Extension to pain (abduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response)
3. Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate
response)
4. Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part
of body away when nailbed pinched)
5. Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-
orbital pressure applied.)
6. Obeys commands. (The patient does simple things as asked.)

Interpretation

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35".

Generally, brain injury is classified as:

 Severe, with GCS ≤ 8


 Moderate, GCS 9 - 12
 Minor, GCS ≥ 13.

Intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score
is given as 1 with a modifier attached e.g. 'E1c' where 'c' = closed, or 'V1t' where t = tube. A composite might be 'GCS 5tc'. This would mean, for
example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'. Often the 1 is left out, so the scale
reads Ec or Vt.

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child
would be expected to be poor). Consequently the Pediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for
assessing younger children.

 Used to assess the conscious level of patients

 Assesses 3 different areas of the patient's response

 Easy to remember if you start at the top and work your way down:-
Unconscious = GCS 8 or below Unconscious
patients are in severe danger of compromising their airway and definite airway management and support should be considered

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