Glasgow Coma Scale

Dennis E. Doherty, MD


March 20, 2001


How would you score the Glasgow coma scale in a postop patient who is admitted to the ICU sedated and paralyzed?

Response from Dennis E. Doherty, MD

The Glasgow Coma Scale is a widely used standardized test that evaluates the degree of nervous system or brain impairment in patients. The patient's status in 3 categories -- Eye Opening, Best Motor Response, and Best Verbal response -- is evaluated to generate the score. The score should be determined once the patient is partially stabilized in the emergency department, or in this case, in the recovery room. The use of sedative and paralyzing agents can confound this assessment and potentially mask underlying nervous system or brain impairment, as it may in this case. This is apparent by reviewing the Table below, which gives the responses used to generate a subscore in each of the 3 categories.

Response from Dennis E. Doherty, MD

Eye Opening E Best Verbal V Best Motor M
spontaneous 4 oriented and converses 5 obeys commands 6
to voice command 3 confused 4 localizes to pain 5
to pain stimuli 2 inappropriate words 3 withdrawals from pain 4
no response 1 incomprehensible sounds 2 decorticate posturing 3
    no sounds 1 decerebrate posturing 2
        no response 1

E + V + M = 3 to 15

Recommended for age > 4 years

The GCS is intended to assess level of consciousness, not follow focal neurologic deficits.

Source: General Medical Officer (GMO) Manual: Clinical Section. Neurosurgical Emergencies Department of the Navy, Bureau of Medicine and Surgery.

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Using this scale in a strict sense, this patient would have a Glasgow Coma Scale score of 3: One point in the Eye Opening Category -- eyes always closed, not attributable to ocular swelling; 1 point in the Best Motor Response category -- no motor response to pain; and 1 point in the Best Verbal Response category -- no sounds.