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 Release 24.0, April 2009
 
The Medical Algorithms Project
Chapter : ch17. Neurology Section : Coma Scales
  Glasgow Coma Scale

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Overview :

The Glasgow coma scale is used to assess patients in coma. The initial score correlates with the severity of brain injury and prognosis.

 

Glasgow coma scale =

= (score for eye opening) + (score for best verbal response) + (score for best motor response)

 

Eye Opening

Score

spontaneously

4

to verbal stimuli

3

to pain

2

never

1

 

 

Best Verbal Response

Score

oriented and converses

5

disoriented and converses

4

inappropriate words

3

incomprehensible sounds

2

no response

1

 

 

Best Motor Response

Score

obeys commands

6

localizes pain

5

flexion withdrawal

4

abnormal flexion (decorticate rigidity)

3

extension (decerebrate rigidity)

2

no response

1

 

Interpretation:

• maximum score is 15 which has the best prognosis

• minimum score is 3 which has the worst prognosis

• scores of 8 or above have a good chance for recovery

• scores of 3-5 are potentially fatal, especially if accompanied by fixed pupils or absent oculovestibular responses

• young children may be nonverbal, requiring a modification of the coma scale for evaluation (see next section)

 

Outcome and Glasgow Coma Scale

Highest Score observed during 1st 24 hours after injury

Good Recovery or Moderate Disability

Vegetative or Dead

3-4

7%

87%

5-7

34%

53%

8-10

68%

27%

11-15

82%

12%

 

  References:

Berkow R, Fletcher AJ. The Merck Manual, 16th edition. Merck Research Laboratories. 1992. Table 124-1, page 1463.

Contant CF Jr, Narayan RK. Chapter 74: Prognosis after head injury. pages 1792-1812. IN: Youmans JR. Neurological Surgery, Fourth Edition. WB Saunders Company. 1996.

Jennett B, Bond M. Assessment of outcome after severe brain damage: A practical scale. Lancet. 1975; 1: 480-485.

Jennett B, Teasdale G, et al. Prognosis of patients with severe head injury. Neurosurgery. 1979; 4: 283-289.

 

 
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