Glasgow Coma Scale (GCS): A Widely Used Classification Scale for Traumatic Brain Injury
Medical Providers and Insurance Companies Use the Glasgow Coma Scale to Assess Brain Injury Severity, Treat Victims, and Predict Outcomes
Medical doctors and researchers have several systems to classify the severity and prognosis of your traumatic brain injury (TBI).
The Glasgow Coma Scale (GSC) is the most widely used of these TBI scales. Doctors use it to assess consciousness after head trauma and watch your recovery in the hours, days, and months after the insult.
Your GCS score determines whether your medical specialists classify your TBI as mild, moderate, or severe. The trend of your Glasgow Coma Scale scores during recovery informs medical treatment decisions and predicts outcomes for future medical care or return to work.
This article explains your Glasgow Coma Scale scores, what they mean, and how to use them to resolve a workers compensation or motor vehicle crash case arising from a head injury. Brain injuries are often invisible to others; you may look okay or normal to others despite having headaches, memory loss, poor concentration, and fatigue. Having clinical signs of traumatic brain injury or concussion can help you get the money you deserve.
Read on to learn more about GSC measurements.
If you have questions about your legal rights, call one of Virginia’s best traumatic brain injury lawyers at (804) 251-1620 or (757) 810-5614.
What is the Glasgow Coma Scale?
First introduced in the 1970s, the Glasgow Coma Scale is the most widely used test to determine the severity of head trauma and neurological status after an accident.
The Glasgow Coma Scale owes its popularity to the following:
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- The GCS is easy for medical professionals (Emergency medical technicians (EMTs), firefighters, emergency room doctors, primary care providers, neurologists, neurosurgeons, and nurses) to administer and score once trained. It is a rapid test.
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- GCS scores vary less between health care providers than diagnostic imaging or neuropsychological testing results.
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- It provides clinical data to inform treatment recommendations.
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- A low GSC score is a reliable predictor of a patient’s outcome after traumatic brain injury.
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- GCS scores can check a patient’s recovery and response to treatment, leading to changes when needed.
When Will I Undergo GSC Testing?
Emergency medical providers will calculate your Glasgow Coma Scale score after checking your airway, breathing, and blood circulation.
However, your GSC score is valid only if done before you take sedatives, paralytics (neuromuscular blocking agents), or pain medication. Taking this medication could lower your score by a couple of points.
Similarly, alcohol or drug intoxication may also skew your Glasgow Coma Scale results.
You may also undergo GSC testing at each clinical examination. Its ease of administration is why it’s become so widespread.
What Does the Glasgow Coma Scale Measure?
The Glasgow Coma Scale measures behavioral responses in three neurological areas: motor, eye-opening, and verbal responses to stimulation.
Your GCS score is the sum of the results from each area. It lets receiving physicians know what to expect before you arrive.
The GCS scale does not go to 0. Instead, the lowest score (being a complete loss of consciousness – you are in a deep coma or vegetative state) is three, and the highest score (representing mild traumatic brain injury where you can respond and communicate with others despite having possible brain damage and ongoing symptoms) is 15.
Let’s look at the three parts of the Glasgow Coma Scale test.
Best Eye-Opening Response (Ocular)
Spontaneous eye opening signifies that the arousal mechanisms in the brainstem are active.
This part of the GCS has four grades:
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- One point: You do not open your eyes spontaneously or to stimulation such as speech or pain.
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- Two points: You open your eyes to noxious stimulation (i.e., heat, pinching, etc.).
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- Three points: You open your eyes to speech (spoken or shouted).
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- Four points: You open your eyes spontaneously.
Medical providers must consider other factors when reviewing the eye-opening scores of brain injury victims. For example:
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- Persons who suffered an eye injury (orbital fracture, enucleation, etc.) in the same work accident or car crash will have difficulty opening their eyes.
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- Comatose patients sometimes open their eyes despite having a severe traumatic brain injury.
Best Verbal Response (Oral)
The ability to speak shows that you have integration in your central nervous system (CNS).
CNS integration means you can process and respond to the information you receive from your environment.
This part of the GCS has five grades:
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- One point: You give no verbal response to questions.
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- Two points: You cannot respond appropriately; however, you can moan or groan.
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- Three points: You speak but need to correct the words or syntax.
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- Four points: You can answer questions but still need clarification.
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- Five points: You can converse normally and give the correct name, location, date, and other essential information.
As with the eye-opening part of the Glasgow Coma Scale, an industrial accident or truck collision may cause other types of injuries that affect GCS scores. For example, intubation due to a spinal cord injury or a language barrier can skew the results.
Best Motor Response (Motor Function)
A motor response shows that your central nervous system is functioning.
To complete this part of the GCS test, the examiner will apply a painful stimulus (squeezing your fingernail bed) and see how you respond. Usually, the examiner will test your motor response in the arms because your arms present a more comprehensive range of reactions.
This part has six grades:
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- One point: You cannot move your arms or legs.
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- Two points: You respond to pain by extending the arm abnormally at the elbow.
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- Three points: You respond to pain by abnormally bending (flexing) the arm.
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- Four points: You can bend the arm normally but withdraw when you feel pain.
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- Five points: You can localize the pain. For example, you may bring your hand above the collarbone to respond to painful stimuli on the head or neck.
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- Six points: You can obey commands such as raising your arm and hand.
What Does My Glasgow Coma Scale Score Mean?
Medical providers use GCS scores to classify your traumatic brain injury as mild, moderate, or severe.
This classification helps predict long-term outcomes.
Mild Traumatic Brain Injury (GCS 13 to 15)
A GCS score from 13 to 15 means you have a mild traumatic brain injury.
For example, a 15/15 on the GCS scale (recorded as M6, V5, E4) means you were fully conscious during the assessment.
Concussions are examples of mild TBIs.
Doctors manage mild traumatic brain injury with home observation, medication, and therapy.
Moderate Traumatic Brain Injury (GCS 9-12)
A GCS score from nine to twelve means you likely have a moderate traumatic brain injury.
Moderate TBIs often lead to extensive medical care and rehabilitation, and result in lifelong disability.
Usually, moderate traumatic brain injury requires observation at the hospital until your condition improves.
Severe Traumatic Brain Injury (GCS 8 or Lower)
A GCS score of eight or lower indicates severe traumatic injury, often resulting from a penetrating head injury, a blast injury, or a crushing blow.
For example, a GCS of 3/15 (recorded as M1, V1, E1) means you do not open your eyes, make noise, or move in response to pain.
Severe TBIs are life-threatening and can leave a patient unconscious. Indeed, severe traumatic brain injury requires treatment in the Intensive Care Unit (ICU).
GCS Score Limitations: What are the Problems with the Glasgow Coma Scale?
Despite its wide acceptance in evaluating head injury patients, the Glasgow Coma Scale has weaknesses and should not be considered a stand-alone assessment for brain damage from trauma.
Limitations of GCS scores include:
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- Glasgow Coma Scale scoring requires subjective interpretation of behavioral responses by doctors, nurses, and first responders. Medical providers may interpret patients’ answers differently, leading to variable scores.
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- A healthcare professional with inadequate training in giving the GCS test may score it incorrectly.
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- A specific GCS score is a snapshot of the patient’s response at a particular time. Any delay in the emergency medical response may result in an inaccurate GCS score. For example, you may have taken the GCS test many minutes or even hours after the initial accident, giving you time to regain consciousness and orientation. Your Glasgow Coma Scale score would not reflect your mental status immediately after the accident.
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- Pre-existing conditions unrelated to the trauma may skew GCS scores.
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- A low score in one Glasgow Coma Scale domain may predict the patient’s outcome better than the total score.
These GCS limitations mean the test has greater validity predicting your likely outcome if you suffer a severe TBI than if you suffer a moderate or mild TBI.
Indeed, traumatic brain injury resulting in postconcussive syndrome with significant cognitive deficits and posttraumatic headaches is possible even if the medical reports from the ambulance or hospital show a GCS of 15/15 and you never lost consciousness. This Glasgow Coma Scale score limitation is
We recommend that you undergo a neuropsychological evaluation for head trauma, regardless of whether you have a GCS score of 13 to 15.
A Skilled Brain Injury Law Firm Uses More than Glasgow Coma Scale Scores to Win Your Claim
Head trauma causing brain damage requires specialized medical care and rehabilitation programs.
Brain injuries also require an attorney with knowledge not only of brain anatomy and the medicine and science behind TBIs but also the strategies necessary to maximize the money you get under tort law, including negligence and occupational injury claims.
Call our firm today at (757) 810-5614 or (804) 251-1620 to learn how we use neuropsychological testing, testimony from others, and medical experts to get results for people with head trauma at every level of the GCS scale.
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