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Título

Glasgow Scale: what is it and how to use it?

Resumo

The Glasgow Coma Scale (GCS) is widely used to assess and calculate the patient's level of consciousness, due to the simplicity of the scoring system and rapid application at the bedside. The objective is to outline a strategy that combines the main indicators of severity in traumatic brain injury (TBI) in a simple scale . There are three criteria: eye opening (up to 4 points), verbal response (up to 5 points) and motor response (up to 6 points). Added together, they give a score between 3 and 15. Eye opening, when spontaneous, takes 4 points. If not, commands are requested, such as calling the patient by name, setting the score to 3. Without response, a painful stimulus is applied (supra orbital notch pressure or trapezius pinching), receiving 2 points. A minimum score of 1 indicates that there are no openings. To assess the verbal response, one asks, for example: “what month is it in?”, “what is your name?”. Responding, the maximum score is given. Otherwise, the extent of their verbal skills is assessed. Sentences can be coherent and complete, but with confusion about time, place or person (4 points). Inappropriate use or disorganized words refers to audible, random and out of context words (3 points). The patient may make noises or moans, without forming any words (2 points). If there is no audible response, the score is minimal. For the motor response, those who fit the maximum score obey commands such as: “close your hands”, “show your tongue”. If negative, the pain response is evaluated with the aforementioned stimuli. In this case, the patient can locate it correctly (5 points); flexing or withdrawing a limb away from the pain stimulus (4 points); perform adduction and internal rotation of the upper limbs (3 points)- “decortication posture” (suggesting damage above the level of the red nucleus)- or even, extend upper and lower limbs (2 points)- “decerebration posture”. With no response, the patient receives 1 point. The GCS is just one part of the neurological system exam. It is also important to assess pupillary reactivity, brainstem reflexes, tendon reflexes , signs of meningismus , and plantar skin response. Together, they can help localize the neurological lesion. Even in the regular observations of an inpatient, attention is paid to the trend of GCS scores, since an abrupt decrease may represent neurological deterioration, requiring urgent additional evaluation.

Palavras Chave

Neurological system exam; Traumatic brain injury; Level of consciousness.