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The Glasgow Coma Scale
 
    The Glasgow Coma Score is the most reliable of the various coma scales currently in use.  It also requires only a brief examination of the patient and can therefore be obtained early on by professional people, such as paramedics.  Because it is easy and quick to determine, it can be repeated frequently.  Scoring the patient often and regularly can help make predictions about the outcome.  Predictions made on the outcome of the patient are typically very accurate and when they err, they do so on the optimistic side.
 
    The Glasgow Coma Scale was designed to meet a need for a standardized initial evaluation.  The scale assesses three components: eye opening, best verbal response, and best motor response.  The lower the mark is, the more severe the brain injury.  The lowest mark possible is 3.  The highest mark possible is 15.  As a patient comes out of coma, the mark rises.  The scale is as follows:
 
Motor Response Example Score
Commands Follows simple commands
6
Localizes Pain Pulls examiner's hand away when pinched
5
Withdraws from Pain Pulls a part of body away when pinched
4
Abnormal Flexion Flexes body inappropriately to pain
3
Abnormal Extension Body becomes rigid in an extended position when examiner pinches him
2
No Response Has no motor response to pinch
1
Eye-Opening  
.
Spontaneous Opens eyes on own
4
To Voice Opens eyes when asked to in a loud voice
3
To Pain Opens eyes when pinched
2
No Response Does not open eyes
1
Verbal Response (Talking)  
.
Orientated Carries on a conversation correctly and tells examiner where he is, who he is, and the month and year
5
Confused Conversation Seems confused or disoriented
4
Inappropriate Words Talks so examiner can understand him but makes no sense
3
Sounds Makes sounds that examiner cannot understand
2
No Response Makes no noise
1
 

A chart that may be helpful to track a patients' progress may look something like this:
 
DAY
1
2
3
4
5
6
7
Motor Response              
Eye Opening              
Verbal Response              
TOTAL              
 
If the patient is receiving drugs, it may impair use of the scale.
 
If the patient rises four levels on the Coma Scale within the first 24 hours, this is considered a rapid improvement.
 
If the patient rises four levels in the Coma Scales in three days, this is considered a moderate improvement.
 
If the patient rises four levels on the Coma Scale in the first week, this is considered a slow improvement.
 
Some patients remain on their original coma score, without a change for weeks. This is called a prolonged coma.
 
Those patients who do not come out of coma may pass into a vegetative state. This state is often characterized by periods of the day during which the person's eyes are open, giving the appearance of wakefulness, but shows no signs that he or she is aware of the environment around him or her. The person is awake, but not aware.
 
 
  References:
Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

 
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