Minimum score in Glassgow Coma Scale: March 2007
Ans. D: 3 The Glasgow Coma Scale or GCS, also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS is 3 (deep coma or death), while the highest is 15 (fully awake person). Best eye response (E) There are 4 grades staing with the most severe: No eye opening - Eye opening in response to pain. (Patient responds to pressure on the patient's fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.) - Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.) - Eyes opening spontaneously Best verbal response (V) There are 5 grades staing with the most severe: - No verbal response - Incomprehensible sounds. (Moaning but no words.) - Inappropriate words. (Random or exclamatory aiculated speech, but no conversational exchange) - Confused. (The patient responds to questions coherently but there is some disorientation and confusion.) 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.) Best motor response (M) There are 6 grades staing with the most severe: - No motor response - Extension to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response) - Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decoicate response) - Flexion/ Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls pa of body away when nailbed pinched) - Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.) Obeys commands. (The patient does simple things as asked.) Interpretation Individual elements as well as the sum of the score are impoant. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 Severity of head injury: Severe: GCS 3-8 Moderate: GCS 9 - 13 Mild head injury: GCS 14-15 with loss of consciousness (LOC) Minor: GCS 15 with no LOC 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). Consequently the Paediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.
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