NCEPOD: Trauma - Who Cares? - London Health Programmes

CAPPENDIX C -Adult and paediatric Glasgow Coma ScaleAdult and paediatricGlasgow Coma ScaleThe Glasgow Coma Scale and Coma Score (GCS)Table Glasgow Coma Scale and Score (Adults)For clarity the Glasgow Coma Scale and Glasgow ComaScore are described below.The Glasgow Coma Scale provides a framework fordescribing the state of a patient in terms of three aspectsof responsiveness: eye opening, verbal response, and bestmotor response, each stratifi ed according to increasingimpairment. In the fi rst description of the Scale for generaluse, the motor response had only fi ve options, with nodemarcation between ‘normal’ and ‘abnormal’ fl exion.The distinction between these movements can be diffi cultto make consistently and is rarely useful in monitoringan individual patient but is relevant to prognosis and is,therefore, part of an extended six option scale used toclassify severity in groups of patients.The Glasgow Coma Score is an artifi cial index; obtained byadding scores for the three responses. The notation for thescore was derived from the extended scale, incorporatingthe distinction between normal and abnormal fl exionmovements, producing a total score of 15. This score canprovide a useful single fi gure summary and a basis forsystems of classifi cation, but contains less information thana description separately of the three responses.FeatureEyeopeningVerbalresponseBest motorresponseScale responsesSpontaneousTo speechTo painNoneOrientatedConfused conversationWords (inappropriate)Sounds (incomprehensible)NoneObey commandsLocalise painFlexion - Normal- AbnormalExtendNoneScorenotation432154321654321Total coma score 3/15 - 15/15The three responses of the coma scale, not the total score,should therefore be of use in describing, monitoring andexchanging information about individual patients.135