{"id":5441,"date":"2025-12-09T12:56:07","date_gmt":"2025-12-09T17:56:07","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=5441"},"modified":"2025-12-09T23:15:24","modified_gmt":"2025-12-10T04:15:24","slug":"glasgow-coma-scale-gcs","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/glasgow-coma-scale-gcs\/","title":{"raw":"11p5  Glasgow Coma Scale (GCS)","rendered":"11p5  Glasgow Coma Scale (GCS)"},"content":{"raw":"<h1><strong>Purpose<\/strong><\/h1>\r\n<ul>\r\n \t<li>Used to\u00a0<strong>quantify<\/strong>\u00a0the level of consciousness in patients with brain injury.<\/li>\r\n \t<li>Guides clinical decisions and monitors progression or improvement.<\/li>\r\n<\/ul>\r\n<h1><strong>Assessment Criteria:<\/strong><\/h1>\r\n<ol>\r\n \t<li><strong>Eye-Opening<\/strong><\/li>\r\n \t<li><strong>Motor Response<\/strong><\/li>\r\n \t<li><strong>Verbal Response<\/strong><\/li>\r\n<\/ol>\r\n<strong>Scoring Range<\/strong>\r\n<ul>\r\n \t<li><strong>Lowest score:<\/strong>\u00a03 (deep coma or unresponsive)<\/li>\r\n \t<li><strong>Highest score:<\/strong>\u00a015 (fully alert)<\/li>\r\n<\/ul>\r\n<strong>\u00a0<\/strong>\r\n<h1><strong>1.\u00a0 Eye Opening (Score 1\u20134) - FYI<\/strong><\/h1>\r\n<table class=\"grid landscape\" style=\"height: 150px\">\r\n<thead>\r\n<tr class=\"shaded\" style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 134.344px\"><strong>Response<\/strong><\/td>\r\n<td style=\"height: 30px;width: 38.775px\"><strong>Score<\/strong><\/td>\r\n<td style=\"height: 30px;width: 275.55px\"><strong>Description<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr style=\"height: 30px\">\r\n<td><strong>Spontaneous<\/strong><\/td>\r\n<td style=\"height: 30px;width: 38.775px\">4<\/td>\r\n<td style=\"height: 30px;width: 275.55px\">Eyes open on their own.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td><strong>Response to speech<\/strong><\/td>\r\n<td style=\"height: 30px;width: 38.775px\">3<\/td>\r\n<td style=\"height: 30px;width: 275.55px\">Eyes open when called or stimulated.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td><strong>Response to pain<\/strong><\/td>\r\n<td style=\"height: 30px;width: 38.775px\">2<\/td>\r\n<td style=\"height: 30px;width: 275.55px\">Eyes open when painful stimulus applied.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td><strong>None<\/strong><\/td>\r\n<td style=\"height: 30px;width: 38.775px\">1<\/td>\r\n<td style=\"height: 30px;width: 275.55px\">No eye opening, unresponsive.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<h1><strong>2.\u00a0 Motor Response (Score 1\u20136) - FYI<\/strong><\/h1>\r\n<table class=\"grid landscape\">\r\n<thead>\r\n<tr class=\"shaded\">\r\n<td><strong>Response<\/strong><\/td>\r\n<td><strong>Score<\/strong><\/td>\r\n<td><strong>Description<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td><strong>Obeys commands<\/strong><\/td>\r\n<td>6<\/td>\r\n<td>Follows instructions (e.g., raise arm).<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Localizes pain<\/strong><\/td>\r\n<td>5<\/td>\r\n<td>Attempts to move toward painful stimulus.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Normal flexion (decorticate)<\/strong><\/td>\r\n<td>4<\/td>\r\n<td>Flexes limbs in response to pain.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Abnormal flexion (decerebrate)<\/strong><\/td>\r\n<td>3<\/td>\r\n<td>Arms extended with abnormal posturing.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Extension (flaccid)<\/strong><\/td>\r\n<td>2<\/td>\r\n<td>No purposeful movement; limp.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>None<\/strong><\/td>\r\n<td>1<\/td>\r\n<td>No response, flaccid.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<strong>Note:<\/strong>\r\n<ul>\r\n \t<li><strong>Decorticate (damage to both cerebral cortexes)<\/strong>: Flexed arms, clenched fists.<\/li>\r\n \t<li><strong>Decerebrate (damage to brainstem)<\/strong>: Extended arms and legs, abnormal rigidity.<\/li>\r\n \t<li><strong>Opisthotonos (damage to extrapyramidal tract)<\/strong>: spastic paralysis in spinal muscles (rigid, arched back)<\/li>\r\n<\/ul>\r\n<h1><strong>3.\u00a0 Verbal Response (Score 1\u20135) - FYI<\/strong><\/h1>\r\n<table class=\"grid landscape\">\r\n<thead>\r\n<tr class=\"shaded\">\r\n<td><strong>Response<\/strong><\/td>\r\n<td><strong>Score<\/strong><\/td>\r\n<td><strong>Description<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td><strong>Oriented<\/strong><\/td>\r\n<td>5<\/td>\r\n<td>Fully alert, knows time and place.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Confused<\/strong><\/td>\r\n<td>4<\/td>\r\n<td>Responds appropriately but confused.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Inappropriate words<\/strong><\/td>\r\n<td>3<\/td>\r\n<td>Random or nonsensical speech.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Incomprehensible sounds<\/strong><\/td>\r\n<td>2<\/td>\r\n<td>No meaningful words, speaking gibberish.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>None<\/strong><\/td>\r\n<td>1<\/td>\r\n<td>No verbal response.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h1><strong>Interpretation of Scores - FYI<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>13\u201315<\/strong>: Mild injury, typically\u00a0<strong>concussion<\/strong>\u00a0or brief unconsciousness.<\/li>\r\n \t<li><strong>9\u201312<\/strong>: Moderate injury,\u00a0<strong>recovery possible<\/strong>.<\/li>\r\n \t<li><strong>3\u20138<\/strong>: Severe injury,\u00a0<strong>deep coma<\/strong>, high risk of death.<\/li>\r\n \t<li><strong>3<\/strong>: Deep coma,\u00a0<strong>no response<\/strong>.<\/li>\r\n<\/ul>\r\n<strong>Prognostic Indicators<\/strong>\r\n<ul>\r\n \t<li><strong>Higher scores<\/strong>\u00a0correlate with\u00a0<strong>better outcomes<\/strong>.<\/li>\r\n \t<li><strong>Scores 4\u20138<\/strong>: Usually indicate\u00a0<strong>coma<\/strong>; survival rate around\u00a0<strong>20-40%<\/strong>.<\/li>\r\n \t<li><strong>Scores above 9<\/strong>: Better chance of recovery, less severe brain damage.<\/li>\r\n<\/ul>\r\n<h1><strong>Monitoring<\/strong><\/h1>\r\n<ul>\r\n \t<li>GCS should be\u00a0<strong>assessed frequently<\/strong>\u00a0(every 2 hours or more).<\/li>\r\n \t<li>Helps track\u00a0<strong>clinical progress<\/strong>\u00a0or deterioration.<\/li>\r\n<\/ul>\r\n<h1><strong>Summary<\/strong><\/h1>\r\n<ul>\r\n \t<li>The GCS provides a\u00a0<strong>standardized assessment<\/strong>\u00a0of brain function.<\/li>\r\n \t<li>Helps determine\u00a0<strong>severity<\/strong>\u00a0of brain injury.<\/li>\r\n \t<li>Critical in guiding\u00a0<strong>treatment plans<\/strong>\u00a0and\u00a0<strong>prognosis<\/strong>.<\/li>\r\n<\/ul>","rendered":"<h1><strong>Purpose<\/strong><\/h1>\n<ul>\n<li>Used to\u00a0<strong>quantify<\/strong>\u00a0the level of consciousness in patients with brain injury.<\/li>\n<li>Guides clinical decisions and monitors progression or improvement.<\/li>\n<\/ul>\n<h1><strong>Assessment Criteria:<\/strong><\/h1>\n<ol>\n<li><strong>Eye-Opening<\/strong><\/li>\n<li><strong>Motor Response<\/strong><\/li>\n<li><strong>Verbal Response<\/strong><\/li>\n<\/ol>\n<p><strong>Scoring Range<\/strong><\/p>\n<ul>\n<li><strong>Lowest score:<\/strong>\u00a03 (deep coma or unresponsive)<\/li>\n<li><strong>Highest score:<\/strong>\u00a015 (fully alert)<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<h1><strong>1.\u00a0 Eye Opening (Score 1\u20134) &#8211; FYI<\/strong><\/h1>\n<table class=\"grid landscape\" style=\"height: 150px\">\n<thead>\n<tr class=\"shaded\" style=\"height: 30px\">\n<td style=\"height: 30px;width: 134.344px\"><strong>Response<\/strong><\/td>\n<td style=\"height: 30px;width: 38.775px\"><strong>Score<\/strong><\/td>\n<td style=\"height: 30px;width: 275.55px\"><strong>Description<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 30px\">\n<td><strong>Spontaneous<\/strong><\/td>\n<td style=\"height: 30px;width: 38.775px\">4<\/td>\n<td style=\"height: 30px;width: 275.55px\">Eyes open on their own.<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td><strong>Response to speech<\/strong><\/td>\n<td style=\"height: 30px;width: 38.775px\">3<\/td>\n<td style=\"height: 30px;width: 275.55px\">Eyes open when called or stimulated.<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td><strong>Response to pain<\/strong><\/td>\n<td style=\"height: 30px;width: 38.775px\">2<\/td>\n<td style=\"height: 30px;width: 275.55px\">Eyes open when painful stimulus applied.<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td><strong>None<\/strong><\/td>\n<td style=\"height: 30px;width: 38.775px\">1<\/td>\n<td style=\"height: 30px;width: 275.55px\">No eye opening, unresponsive.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h1><strong>2.\u00a0 Motor Response (Score 1\u20136) &#8211; FYI<\/strong><\/h1>\n<table class=\"grid landscape\">\n<thead>\n<tr class=\"shaded\">\n<td><strong>Response<\/strong><\/td>\n<td><strong>Score<\/strong><\/td>\n<td><strong>Description<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong>Obeys commands<\/strong><\/td>\n<td>6<\/td>\n<td>Follows instructions (e.g., raise arm).<\/td>\n<\/tr>\n<tr>\n<td><strong>Localizes pain<\/strong><\/td>\n<td>5<\/td>\n<td>Attempts to move toward painful stimulus.<\/td>\n<\/tr>\n<tr>\n<td><strong>Normal flexion (decorticate)<\/strong><\/td>\n<td>4<\/td>\n<td>Flexes limbs in response to pain.<\/td>\n<\/tr>\n<tr>\n<td><strong>Abnormal flexion (decerebrate)<\/strong><\/td>\n<td>3<\/td>\n<td>Arms extended with abnormal posturing.<\/td>\n<\/tr>\n<tr>\n<td><strong>Extension (flaccid)<\/strong><\/td>\n<td>2<\/td>\n<td>No purposeful movement; limp.<\/td>\n<\/tr>\n<tr>\n<td><strong>None<\/strong><\/td>\n<td>1<\/td>\n<td>No response, flaccid.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Note:<\/strong><\/p>\n<ul>\n<li><strong>Decorticate (damage to both cerebral cortexes)<\/strong>: Flexed arms, clenched fists.<\/li>\n<li><strong>Decerebrate (damage to brainstem)<\/strong>: Extended arms and legs, abnormal rigidity.<\/li>\n<li><strong>Opisthotonos (damage to extrapyramidal tract)<\/strong>: spastic paralysis in spinal muscles (rigid, arched back)<\/li>\n<\/ul>\n<h1><strong>3.\u00a0 Verbal Response (Score 1\u20135) &#8211; FYI<\/strong><\/h1>\n<table class=\"grid landscape\">\n<thead>\n<tr class=\"shaded\">\n<td><strong>Response<\/strong><\/td>\n<td><strong>Score<\/strong><\/td>\n<td><strong>Description<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong>Oriented<\/strong><\/td>\n<td>5<\/td>\n<td>Fully alert, knows time and place.<\/td>\n<\/tr>\n<tr>\n<td><strong>Confused<\/strong><\/td>\n<td>4<\/td>\n<td>Responds appropriately but confused.<\/td>\n<\/tr>\n<tr>\n<td><strong>Inappropriate words<\/strong><\/td>\n<td>3<\/td>\n<td>Random or nonsensical speech.<\/td>\n<\/tr>\n<tr>\n<td><strong>Incomprehensible sounds<\/strong><\/td>\n<td>2<\/td>\n<td>No meaningful words, speaking gibberish.<\/td>\n<\/tr>\n<tr>\n<td><strong>None<\/strong><\/td>\n<td>1<\/td>\n<td>No verbal response.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h1><strong>Interpretation of Scores &#8211; FYI<\/strong><\/h1>\n<ul>\n<li><strong>13\u201315<\/strong>: Mild injury, typically\u00a0<strong>concussion<\/strong>\u00a0or brief unconsciousness.<\/li>\n<li><strong>9\u201312<\/strong>: Moderate injury,\u00a0<strong>recovery possible<\/strong>.<\/li>\n<li><strong>3\u20138<\/strong>: Severe injury,\u00a0<strong>deep coma<\/strong>, high risk of death.<\/li>\n<li><strong>3<\/strong>: Deep coma,\u00a0<strong>no response<\/strong>.<\/li>\n<\/ul>\n<p><strong>Prognostic Indicators<\/strong><\/p>\n<ul>\n<li><strong>Higher scores<\/strong>\u00a0correlate with\u00a0<strong>better outcomes<\/strong>.<\/li>\n<li><strong>Scores 4\u20138<\/strong>: Usually indicate\u00a0<strong>coma<\/strong>; survival rate around\u00a0<strong>20-40%<\/strong>.<\/li>\n<li><strong>Scores above 9<\/strong>: Better chance of recovery, less severe brain damage.<\/li>\n<\/ul>\n<h1><strong>Monitoring<\/strong><\/h1>\n<ul>\n<li>GCS should be\u00a0<strong>assessed frequently<\/strong>\u00a0(every 2 hours or more).<\/li>\n<li>Helps track\u00a0<strong>clinical progress<\/strong>\u00a0or deterioration.<\/li>\n<\/ul>\n<h1><strong>Summary<\/strong><\/h1>\n<ul>\n<li>The GCS provides a\u00a0<strong>standardized assessment<\/strong>\u00a0of brain function.<\/li>\n<li>Helps determine\u00a0<strong>severity<\/strong>\u00a0of brain injury.<\/li>\n<li>Critical in guiding\u00a0<strong>treatment plans<\/strong>\u00a0and\u00a0<strong>prognosis<\/strong>.<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":12,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5441","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":76,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5441","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":6,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5441\/revisions"}],"predecessor-version":[{"id":5549,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5441\/revisions\/5549"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/76"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5441\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5441"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5441"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5441"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5441"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}