You may have heard, or heard a doctor talking about these three letters "GCS" in a hospital. Perhaps when someone close to you has had an accident, or suddenly loses consciousness, doctors talk about this GCS value. So, what is this GCS, why is it so important, and what exactly does it measure, let's talk in detail and very simply today. My goal is to give you a clear understanding of this.
Simply put, what is GCS (Glasgow Coma Scale)?
The GCS is, to be precise, a way of measuring a person's level of consciousness . It's like a scoring system. It scores things like how alert you are, how aware you are of your surroundings, and how well you respond to simple instructions.
This system was first introduced in 1974 by a team of specialists at the University of Glasgow in Scotland. Despite the word "coma" in the name, the GCS is now used in a much broader context in medicine. It is the main and most widely used scale used to measure states of reduced consciousness, including coma.
What is "consciousness" in medical terms?
When we talk about "consciousness" in medicine, there are three main requirements. For someone to be said to be conscious, these things must be fulfilled:
- Awake: This refers to whether someone can wake you up when you speak or touch your body. This is the difference between just sleeping and being in a coma.
- Alertness: This means how you respond when someone speaks to you, where you are, and whether you can understand what is happening around you.
- You need to be aware (Oriented): This means that you know the details relevant to your current situation, such as who you are, where you are, and what day it is.
If all three of these things are in place, we say that someone is "of sound mind."
When is the GCS (Glasgow Coma Scale) used?
Doctors can use GCS as part of a neurological exam . It is also useful in any situation where a person may be losing consciousness. For example, in conditions caused by head injuries, such as concussions and traumatic brain injuries (TBI) .
Not only that, but the GCS scale is also helpful in cases of loss of consciousness due to other causes than injury. For example, it is used in cases of very low blood sugar levels (hypoglycemia) , poisoning, or after a seizure.
What does the GCS (Glasgow Coma Scale) measure?
A neurological exam looks for any problems with the functioning of the two main parts of our nervous system. These two parts are:
- Central nervous system: This includes your brain, brainstem, optic nerves that connect the brain to the retina at the back of your eyes, and spinal cord.
- Peripheral nervous system: This refers to all the nerves that are not part of the central nervous system.
There are three main areas of the GCS that are relevant to this neurological examination. Most of these are related to the brain itself, but some can also involve the spinal cord and nerves throughout the body:
- Eye response: This is mainly related to how awake and alert you are.
- Motor response: This section looks at how well your brain can control muscle movement. It can also detect any problems with the connections between your brain and other parts of your body.
- Verbal response: This tests how well certain brain functions are working, such as thinking, memory, attention, and awareness of your surroundings.
How does the GCS (Glasgow Coma Scale) work?
To find your GCS score, doctors add up the scores from the three previous sections of the GCS. A doctor will test each of these sections in different ways. For example, they will look at your verbal response and ask you a few questions. What day of the week is it today, what time is it, and what city are you in right now?
One of the most important benefits of the GCS is that it can monitor changes in your level of consciousness. Doctors often repeat this neurological test at specific intervals and record changes in the GCS score.
Here is how these sections are scored:
Eye Response
This mainly measures how awake you are. If you are unconscious, your level of unconsciousness is measured by testing your reflex responses to pressure. Here, "pressure" is something like a gentle pressure with a fingernail. It should only cause minor, temporary discomfort, not injury.
Verbal Response
A doctor will test this by asking you questions that measure your memory, thinking ability, and awareness of your surroundings. It can also check for problems with the brain or nerves that control the muscles in your face and mouth.
Motor Response
This section can reveal any problems with the connections between your nerves, spinal cord, and brain. It also tests your brain's ability to control muscle movement and whether you can understand and act on instructions.
What is GCS-P?
In 2018, a team of experts — including one of the original creators of the GCS — released a revised version of the GCS, called "GCS-P." The P stands for "Pupil," the black hole inside the eye. This is a fourth number subtracted from the standard GCS score.
The way the pupil of the eye responds to light (Pupil reaction) is very important because it provides clues about brain function. If your pupil does not respond to light, it can indicate a serious problem or injury affecting the brain.
The score given to the pupil ranges from 0 to 2.
- 2: Both corneas do not respond to light.
- 1: One pupil does not respond to light.
- 0: Both corneas respond to light.
When the pupil response score is subtracted from the GCS score, the GCS-P score can range from 1 to 15. A GCS-P score of 8 or less indicates a coma.
For example, if the GCS score is 3 and the iris score is 2, the GCS-P score is 1. This means a very deep coma and the irises in both eyes do not respond to light.
Is there pain during the GCS test?
Older descriptions of the GCS used the word "pain" to describe the sensation used to test certain reflexes. However, the new guidelines have changed that word to "pressure." This change of wording is more accurate, because there is no injury involved. It is also clearer because the doctor is not actually trying to cause pain or hurt your loved one.
The original GCS guidelines did not clearly state where to apply pressure to test reflexes. In 1975, a year after the GCS was first published, the experts who developed it published specific guidelines. Here are some of the places a doctor might apply pressure to:
- Nail beds: The nails on your hands and feet are sensitive to pressure. Doctors often press on one or more of these to see if the body responds in a reflex to that pressure.
- Trapezius muscle: This muscle connects your shoulders, middle neck, and back. It's an easy muscle to reach for a pressure reflex.
- Supraorbital notch: This is a small depression in your skull, above your eyes and below your eyebrows.
What are the results, and what do they tell us?
The highest possible score on the GCS is 15, and the lowest is 3. A score of 15 means you are fully awake, responsive, and have no problems with your thinking or memory. Typically, a score of 8 or less means you are in a coma. The lower the score, the deeper the coma.
Doctors may write your GCS score as a combination of letters/numbers. For example, a score of 15 would be written as "E4V5M6". A score of 3 would be written as "E1V1M1". (E=Eye, V=Verbal, M=Motor)
GCS Ranges for Head Injuries
When doctors use the GCS for a head injury, they use ranges of scores to describe the severity of the injury. These ranges are:
- 13 to 15: Mild Traumatic Brain Injury (mTBI). This is also called a concussion .
- 9 to 12: Moderate TBI.
- 3 to 8: Severe brain injury (Severe TBI).
What should I know about the GCS score of someone close to me?
Typically, your family or loved ones will discuss your GCS score with your doctor. There are a few things you should know about the GCS and how doctors use it:
- Test results are more complex than just a number. The GCS score does not tell you the full extent of the test results. There is more to a neurological exam than just a number. While it is easy to understand the number, it is best to talk to your loved one's doctor to understand their exact condition.
- GCS also has limitations. In some cases, GCS may not be useful. For example, if a person is on a ventilator , or if they do not speak the same language as the doctor. It also may not be useful for people with conditions or injuries that affect the body parts or systems that GCS relies on (e.g., vision or hearing impairments).
- The GCS is not the only factor that doctors use to predict prognosis. Doctors often use the GCS to predict possible outcomes, but it is not the only factor they consider. Ask your loved one's doctor about their score and what it might mean in the long term.
Remember, the GCS score is just one tool. While it provides important information, good communication with the medical team is essential to understand the full picture.
Finally, what to remember
The Glasgow Coma Scale (GCS) is a very common and important tool that doctors use to measure levels of consciousness and coma. Although it has been around for nearly 50 years, experts have studied the scale extensively and found it to be a useful diagnostic tool. (They have also improved it over time.) Using the scale also helps doctors monitor changes in brain function. This can help them better treat and improve care for people with conditions that affect consciousness.
If you or someone close to you is experiencing this, don't be afraid to ask questions and get information from your doctors. They are ready and willing to help you.
` Consciousness, GCS, Glasgow Coma Scale, Brain Injury, Coma, Neurological Examination, Health
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