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Assessment of level of consciousness using Glasgow Coma Scale tools | The BMJ

This article provides an overview of the Glasgow Coma Scale (GCS) and its related tools for assessing the level of consciousness in patients with acute brain impairment.

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Paul M Brennan, reader, honorary consultant neurosurgeon, clinical director1,
Charlotte Whittingham, core trainee2,
Virendra Deo Sinha, head of department3,
Graham Teasdale, emeritus professor of neurosurgery4

1Centre for Clinical Brain Sciences, University of Edinburgh and NHS Lothian, Edinburgh EH16 4SB, UK
2Emergency Medicine Department, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
3Neurosurgery, Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur, India
4Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK

Correspondence to: P M Brennan paul.brennan{at}ed.ac.uk

What you need to know

The Glasgow Coma Scale (GCS) is a well known tool to assess a patient’s level of consciousness
The GCS Aid is an adjunct to the GCS and provides a structured approach to assessing consciousness. It was devised to provide a framework for standardised examination and to support consistent, reliable GCS assessment
The GCS Pupils score is a simple scoring system that may be used to estimate a patient's outcome. It is not a replacement for the GCS

For patients with a traumatic brain injury or other acute brain impairment (such as stroke, infective cerebritis, or toxic encephalopathy), assessment of their clinical condition, and how it may change, is fundamental to their care. For almost 50 years, the Glasgow Coma Scale (GCS) has been used worldwide to assess a patient’s responsiveness, or level of consciousness,1 in acute brain impairment.2 When using the GCS, the response of a patient is documented in three components: eyes, verbal, and motor. Each of these components is assessed simultaneously. Over time, lessons learnt have prompted developments to support and extend the usefulness of the GCS. Awareness of the various GCS tools is useful for all doctors involved in the assessment or management of acutely unwell patients. This article offers an overview of the most recent updates, including the GCS Aid,3 GCS Pupils score (GCS-P),45 and the verbal imputation score.6 We discuss how to apply these tools in clinical practice.

Why do we assess level of consciousness?

Assessment of a patient’s level of consciousness with the GCS provides an index of the likelihood of intracranial complications before further deterioration occurs. The management of patients with reduced consciousness is influenced by their clinical condition and the potential causes (box 1). Investigation of the possible causes requires review of a patient’s clinical history, a thorough clinical assessment, and investigations such …