Glasgow Coma Scale (GCS): An Overview of Its Use in Traumatic Brain Injury Cases
Medical Providers Use the Glasgow Coma Scale to Assess Brain Injury Severity, Treat Victims, and Predict Outcomes
The Glasgow Coma Scale (GCS) is a tool many medical providers use to assess consciousness after a brain injury and monitor your recovery in the hours, days, and months following the trauma.
Your GCS score determines the classification of the severity of your traumatic brain injury: mild, moderate, or severe. And it informs medical treatment decisions and predicts outcomes.
This article describes the Glasgow Coma Scale and your GSC scores’ role in successfully resolving a workers compensation, Social Security disability, or motor vehicle crash case. Brain injuries are often invisible to others; you may look okay or normal to others despite having headaches, memory loss, poor concentration, and fatigue. So having clinical signs of traumatic brain injury or concussion can help you get the money you deserve.
Keep reading to learn more about the Glasgow Coma Scale, then check out our other articles on the medical and legal aspects of traumatic brain injury claims.
If you have questions about your legal rights, call me at (804) 251-1620 or (757) 810-5614.
Why is the Glasgow Coma Scale Useful?
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 GCS owes its popularity to the following:
- It is easy for health care professionals (first responders, emergency room doctors, nurses, primary care providers, neurologists, neurosurgeons) to administer. Indeed, the GCS is a rapid test.
- GCS scores vary less between health care providers than diagnostic imaging or neuropsychological testing. However, the Glasgow Coma Scale still requires subjective interpretation of behavioral responses by doctors, nurses, and first responders.
- It provides clinical data to inform treatment recommendations.
- A low GSC score is a reliable predictor of a patient’s outcome after brain injury.
- GCS scores can monitor a patient’s recovery and response to treatment.
How is the Glasgow Coma Scale Scored?
The Glasgow Coma Scale measures behavioral responses in three neurological areas: motor responses, eye-opening, and verbal responses to stimulation.
Your GCS score is the sum of the results from each area.
The GCS does not go to 0. Instead, the lowest score (representing a complete loss of consciousness – you are in a deep coma or vegetative state) is three, and the highest score (representing a mild traumatic brain injury where you can respond and communicate with others despite having possible brain damage) is 15.
Now let’s look at each part of the Glasgow Coma Scale test.
Best Eye-Opening Response
Spontaneous eye opening signifies that the arousal mechanisms in the brainstem are active.
This part of the GCS has four grades:
- One point: You do not open your eyes spontaneously or to stimulation such as speech or pain.
- Two points: You open your eyes to noxious stimulation (i.e., heat, pinching, etc.).
- Three points: You open your eyes to speech (spoken or shouted).
- Four points: You open your eyes spontaneously.
Medical providers must consider other factors when reviewing the eye opening score in brain injury victims. For example:
- Persons who suffered an eye injury (orbital fracture, enucleation, etc.) in the same work accident or car crash will have difficulty opening their eyes.
- Comatose patients sometimes open their eyes despite having a severe traumatic brain injury.
Best Verbal (Oral) Response
The ability to speak indicates that you have integration in your central nervous system (CNS).
And CNS integration means you can process the information you receive from your environment then respond.
This part of the GCS has five grades:
- One point: You give no verbal response to questions.
- Two points: You cannot respond appropriately; however, you can moan or groan.
- Three points: You speak but use the wrong words or syntax.
- Four points: You can answer questions but still act disoriented or confused.
- 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 GCS, some injuries suffered with TBI may affect the scoring.
For example, intubation due to a spinal cord injury or a language barrier can skew the results.
Best Motor Response
A motor response indicates 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 wider range of reactions.
This portion has six grades:
- One point: You cannot move your arms or legs.
- Two points: You respond to pain by extending the arm abnormally at the elbow.
- Three points: You respond to pain by bending (flexing) the arm abnormally.
- Four points: You can bend the arm normally but withdraw when you feel pain.
- Five points: You can localize the pain. For example, you may bring your hand above the collar bone to respond to painful stimuli on the head or neck.
- Six points: You can obey commands such as raising your arm and hand.
What do the Glasgow Coma Scores Mean?
Medical providers use GCS scores to determine if your traumatic brain injury is mild, moderate, or severe.
Mild Traumatic Brain Injury (Glasgow Coma Scale Score of 13 to 15)
A GCS score from 13 to 15 means you likely have a mild traumatic brain injury.
Concussions are examples of mild TBIs.
Doctors manage mild traumatic brain injury with home observation, medication, and therapy.
Moderate Traumatic Brain Injury (Glasgow Coma Scale Score of 9 to 12)
A GCS score from nine to twelve means you likely have a moderate traumatic brain injury.
Moderate TBIs require extensive medical care and rehabilitation, often resulting in lifelong disability.
Usually, moderate traumatic brain injury requires observation at the hospital until your condition improves.
Severe Traumatic Brain Injury (Glasgow Coma Scale Score of 8 or Lower)
A GCS score of eight or lower indicates severe traumatic injury, often resulting from a penetrating head injury or a crushing blow.
Severe TBIs are life-threatening and can leave a patient unconscious. Indeed, severe traumatic brain injury requires treatment in the Intensive Care Unit (ICU).
Can I Have a TBI with a GCS Score of 15?
Yes.
Traumatic brain injury resulting in significant cognitive deficits and posttraumatic headaches is possible even if the medical reports from the ambulance or hospital show a GCS of 15/15.
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. In this situation, your GCS score would not reflect your mental status immediately after the accident.
In addition, you can have a TBI without loss of consciousness.
If you suspect traumatic brain injury despite GSC scores indicating full consciousness, look for other signs of damage, such as:
- Scalp lacerations
- Head bruising
- Vision loss
- Hearing loss
- Leaking fluid from the ears or nose
- Loss of smell
A TBI without loss of consciousness (a concussion) can still cause severe, life-long problems. And you can still recover money damages for a concussion through a workers comp claim or personal injury lawsuit.
Do Health Care Providers Use Other Classification Systems to Determine TBI Severity?
Yes.
Although the Glasgow Coma Scale is the most popular test to determine brain injury levels, it is not the only one.
Your medical providers may use the Pediatric Glasgow Coma Scale for TBIs in children, the Mayo Classification System for Traumatic Brain Injury, and the Rancho Los Amigo Scale.
Call a Brain Injury Attorney to Prosecute Your Legal Rights
Traumatic brain injuries require specialized medical care and rehabilitation programs.
They 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, workers comp, and Social Security disability.
Call me today at (757) 810-5614 or (804) 251-1620 to learn how our law firm can help you.
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