|Glasgow Coma Score|
|Eye Opening (E)||Verbal Response (V)||Motor Response (M)|
3=Words, but not coherent
2=No words......only sounds
5=Localizes to pain
4=Withdraws to pain
|Total = E+V+M|
The Glasgow Coma Scale 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 interobserver reliability and because it correlates well with outcome following severe brain injury.
It is easy to use, particularly if a form is used with a table similar to the one above. One determines the best eye opening response, the best verbal response, and the best motor response. The score represents the sum of the numeric scores of each of the categories. There are 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 acurately reflect the severity of a traumatic brain injury. So, shock, hypoxemia, drug use, alcohol intoxication, metabolic disturbances may alter the GCS independently of the brain injury. 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. In spite of these limitations, it is quite useful and is far and away the most widely used scoring system used today to assess patients with traumatic brain injury.