GCS
• Was developed to assess the level of neurologic injury, including movements, speech, and eye-opening
assessments.
• Is a neurological scale that aims to give a reliable and objective way of recording the conscious state of
a person for initial as well as subsequent assessment.
• The scale was published in 1974 by graham Teasdale and Bryan Jennett, professors of neurosurgery at
the University of Glasgow’s institute of neurological sciences at the city’s southern general hospital.
• Is a neurological scale that aims to give reliable way of recording the conscious state of a person.
GCS has 3 components
Eye Response (1-4)
Verbal Response (1-5)
Motor Response (1-6)
EYE RESPONSE
1. No eye opening
2. Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the
lunula area of the patient’s fingernails more effective than a central stimulus such as trapezius
squeeze, due to grimacing effect).
3. Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such
patients receive a score of 4, not 3.
4 Eye opening spontaneouslyEYE
VERBAL RESPONSE
• There are five 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.
Speaks words but no sentences.)
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.)
]
MOTOR RSPONSE
• There are six grades starting with the most severe:
1. No motor response
2. Decerebrate posturing accentuated by pain (extensor response adduction of arm, internal
rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers,
leg extension, plantar flexion of foot)
Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm
and wrist with clenched fist, leg extension, plantar flexion of foot)
STIMULI
STIMULI
• Stimuli used during the assessment can range from verbal or audible stimuli to painful/pressure stimuli.
• There are two types of painful/pressure stimuli that can be used to achieve a response in a patient.
These types include: central and peripheral stimuli
Central stimuli: pressure or pain is applied to the center of the body (hence its core) to create pain. This tests
the brain’s response to it.
• Used first is the trapezius squeeze
• To do this: use the index finger and thumb and squeeze 1 ½ to 2 inches of this trapezius muscle.
• Start with slight pressure and then increase the pressure for up to 10 seconds… note patient’s
motor movement
• No response…move to the supraorbital pressure:
STIMULI
• Find the notch under the inner part of the eyebrow
• Apply pressure to this notch with the thumb and gradually increase pressure for up to 10
seconds…. note patient’s motor movement
• Sternal rub is no longer recommended because it can cause bruising (BMJ case reports, 2014).
Peripheral stimuli: pressure or pain is applied to a peripheral extremity like the fingernail bed to create pain.
This tests the spinal cords response to pain.
INTERPRETATION
Generally, brain injury is classified as:
• Severe, GCS <8-9
• Moderate, GCS 8 or 9-12
• Minor, GCS ≥ 13
LIMITATION
• Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and
eye response.
• In these circumstances the score is given as 1 with a modifier attached (e.g. “E1c”, where “c” = closed,
or “V1t” where t = tube). 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).
