| The
Glasgow Coma Scale |
|
The Glasgow Coma Score is the
most reliable of the various coma scales currently in
use. It also requires only a brief examination of
the patient and can therefore be obtained early on by
professional people, such as paramedics. Because
it is easy and quick to determine, it can be repeated
frequently. Scoring the patient often and regularly
can help make predictions about the outcome. Predictions
made on the outcome of the patient are typically very
accurate and when they err, they do so on the optimistic
side. |
|
The Glasgow
Coma Scale was designed to meet a need for a standardized
initial evaluation. The scale assesses three components:
eye opening, best verbal response, and best motor response.
The lower the mark is, the more severe the brain
injury. The lowest mark possible is 3. The
highest mark possible is 15. As a patient comes
out of coma, the mark rises. The scale is as follows:
|
| |
| Motor
Response |
Example |
Score |
| Commands |
Follows
simple commands |
6 |
| Localizes
Pain |
Pulls
examiner's hand away when pinched |
5 |
| Withdraws
from Pain |
Pulls
a part of body away when pinched |
4 |
| Abnormal
Flexion |
Flexes
body inappropriately to pain |
3 |
| Abnormal
Extension |
Body
becomes rigid in an extended position when examiner
pinches him |
2 |
| No
Response |
Has
no motor response to pinch |
1 |
| Eye-Opening |
|
. |
| Spontaneous |
Opens
eyes on own |
4 |
| To
Voice |
Opens
eyes when asked to in a loud voice |
3 |
| To
Pain |
Opens
eyes when pinched |
2 |
| No
Response |
Does
not open eyes |
1 |
| Verbal
Response (Talking) |
|
. |
| Orientated
|
Carries
on a conversation correctly and tells examiner where
he is, who he is, and the month and year |
5 |
| Confused
Conversation |
Seems
confused or disoriented |
4 |
| Inappropriate
Words |
Talks
so examiner can understand him but makes no sense |
3 |
| Sounds |
Makes
sounds that examiner cannot understand |
2 |
| No
Response |
Makes
no noise |
1 |
|
| |
|
| |
A chart that may be helpful to track a patients' progress
may look something like this:
|
| |
| DAY |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
| Motor
Response |
|
|
|
|
|
|
|
| Eye
Opening |
|
|
|
|
|
|
|
| Verbal
Response |
|
|
|
|
|
|
|
| TOTAL |
|
|
|
|
|
|
|
|
| |
If the patient is receiving drugs, it may impair use of
the scale.
|
| |
If the patient rises four levels on the Coma Scale within
the first 24 hours, this is considered a rapid improvement.
|
| |
If the patient rises four levels in the Coma Scales in
three days, this is considered a moderate improvement.
|
| |
If the patient rises four levels on the Coma Scale in
the first week, this is considered a slow improvement.
|
| |
Some patients remain on their original coma score, without
a change for weeks. This is called a prolonged coma.
|
| |
Those patients who do not come out of coma may pass into
a vegetative state.
This state is often characterized by periods of the day
during which the person's eyes are open, giving the appearance
of wakefulness, but shows no signs that he or she is aware
of the environment around him or her. The person is awake,
but not aware.
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