Glasgow Coma Scale

Aka: Glasgow Coma Scale, Pediatric Glasgow Coma Scale, GCS

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II. Indications

  1. Head Injury

III. Scoring

  1. Eye Opening
    1. Spontaneous: 4
    2. To speech: 3
    3. To pain or pressure: 2
    4. No Response: 1
  2. Best Verbal Response
    1. Oriented (Infant coos or babbles): 5
    2. Confused (Infant irritable cries): 4
    3. Inappropriate words (Infant Cries to pain): 3
    4. Incomprehensible sounds (Infant Moans to pain): 2
    5. No Response: 1
  3. Best Motor Response
    1. Obeys (Infant moves spontaneous/purposefully): 6
    2. Localizes (infant withdraws to touch): 5
    3. Withdraws to pain: 4
    4. Abnormal Flexion (Decorticate Posturing): 3
    5. Abnormal Extension (Decerebrate Posturing): 2
    6. No Response: 1

IV. Interpretation

  1. Total: 3-15
  2. Mild Head Injury: 13-15 (at two hours post-injury)
  3. Moderate Head Injury: 9-12 (at two hours post-injury)
  4. Severe Head Injury (Coma): <= 8 (at two hours post-injury)
    1. Confers Significant Mortality Risk
  5. Modifiers
    1. Not-Tested (NT)
      1. Use NT to mark items that could not be tested (e.g. intubated patient)
      2. Example: E-1, V-NT, M-3

V. References

  1. Swaminathan and Hicks in Herbert (2020) EM:Rap 20(1):6-7
  2. Morray (1984) Crit Care Med 12: 1018 [PubMed]
  3. Teasdale (1974) Lancet 2:81-4 [PubMed]
  4. Davis (1987) in Rogers, Textbook of Ped Int Care

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