The Glasgow Coma Scale: Setting the Bar for Brain Injury Evaluation

The Glasgow Coma Scale (GCS) is one of medicine's most critical assessment tools for traumatic brain injuries. In this episode, “The Glasgow Coma Scale: Setting the Bar for Brain Injury Evaluation," MEC’s Peggy Ford, a Senior National Medical Catastrophe Consultant with over 30 years of experience, provides essential knowledge about how the GCS measures brain injury severity.

Peggy offers valuable insights into this evaluation method, which has become the cornerstone of neurological tests worldwide in emergency settings. It includes a scoring system that allows medical professionals to quickly categorize the severity of brain injuries and make critical treatment decisions in time-sensitive situations where every moment matters. She explains:

• How the scale rates three key aspects of traumatic brain injuries — eye opening, verbal response, and motor response — to generate scores ranging from 3 (completely unresponsive) to 15 (fully alert).
• Why understanding the nuances of each category is essential for accurate assessment.
• The science behind brain injury measurement. 
• Factors that can compromise proper evaluation. 

Listen now to gain key insights on the importance of standardized assessment tools like the GCS in guiding initial treatment approaches and providing valuable prognostic information for healthcare providers, patients, and families during vital stages of care.

Chapters

• 0:00 Introduction to MEC Expert Insights
• 0:36 Glasgow Coma Scale Overview
• 1:50 Breaking Down Scale Categories
• 4:40 Assessment Challenges and Reliability
• 6:25 Episode Conclusion and Contact Info

Transcript

Sara Hance: 0:05

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers' Casualty. I'm Sara Hance and in these Expert Insights episodes you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Peggy Ford, Senior National Medical Catastrophic Consultant, will discuss the Glasgow Coma Scale. Now let's hear from Peggy.

Peggy Ford: 0:36

Good day. My name is Peggy Ford from Midwest Employers' Casualty. I work as a Senior National Medical Catastrophic Consult consultant. I want to share some of my experience over the past 30 plus years working in the workers' compensation arena. Today I'm going to give you a quick working knowledge regarding the Glasgow Coma Scale.

Peggy Ford: 0:57

The Glasgow Coma Scale is almost universally utilized to assist in determining the extent of an injured person's loss of consciousness with a brain injury for individuals over the age of five. Earc published in 1974 by neurosurgeon professors at the University of Glasgow, graham Teasdale and Brian Jennett. It is considered simple, reliable and correlates well with outcome following brain injury. After injury, the Glasgow Coma Scale will be repeated if needed and the score updated. It should be stated here that traumatic brain injury is a leading cause of death and disability in the United States and around the world. The scores are divided into three aspects of responsiveness with the goal of providing a clear, communicable picture that will assist in determining emergent treatment. However, one must also address that a prediction of outcome after traumatic brain injury will vary based on the multiple factors of the individual. However, we do need to have a starting point and the Glasgow Coma Scale provides that assistance. Eye-opening, motor and verbal are the three categories that are utilized. The lowest score is 3, and the best score is 15. A score from 3 to 8 is considered a severe traumatic brain injury, with poor outcomes and mortality rates as high as 76%. 9 to 12 is considered moderate. This group will usually have favorable outcomes 75% after treatment. If you score between 13 and 15, that's considered a mild traumatic brain injury and you usually have a full to good recovery.

Peggy Ford: 2:50

Now let's break down the categories. There are four numbers for eye opening and they range from 1 to no eye opening, 2, open to pain stimulus, 3, open to sound and four spontaneous opening. There are five numbers assigned for a verbal response. One is no verbal response. Two it's garbled speech or incomprehensible, in other words, it's not understandable in what they are trying to communicate. Three is inappropriate words utilized for the subject matter. Four is confused either an inappropriate response or asking questions, and five is considered oriented.

Peggy Ford: 3:42

There are six categories from BODER, one being no motor response. Two is an abnormal extension to pain, so, for instance, the head is extended, arms and legs are extended and internally rotated. Three is an abnormal flexion to pain and the flexor response is to pull away from pain, in this case, the arms respond in a less purposeful way. There may be rotations of the shoulders and the arms and wrists, and the movements of the arms do not go above nipple height. Four is withdrawing from pain. Five is localizing pain, for instance reaching toward the site where the painful stimulus is being applied. And six is obeying commands.

Peggy Ford: 4:39

Now, going with this information, a person with a Glasgow Coma Scale of three would be totally unresponsive. A person with a Glasgow Coma Scale of seven could be eyes open to sound, inappropriate word usage and withdrawal from pain. 15 is the optimal score. Your eyes respond pain-free, opening, you're oriented and you obey commands without issue.

Peggy Ford: 5:01

Now, one area is that there are several factors that may interfere with assessment, and this includes language barriers, intellectual or neurological deficits, hearing or speech impediment, low blood oxygen, shock if the person's intubated, if they have any fractures, use of medication and alcohol that could alter consciousness, if they have spinal cord damage, eye injury, damage, any comorbidities that would interfere, and if they have a psychological status that would interfere. There's a myriad of areas that can impact each single person differently. The Glasgow Coma Scale has been studied extensively, with 85% of studies showing substantial reliability. Reproducibility of the number determined upon assessment is also demonstrated by others completing an assessment. However, there are always movements to provide a more advanced technique to provide data, but for now, the Glasgow Coma Scale is the preferred method. Thank you for listening today. I hope you learned some additional or new tidbits regarding the Glasgow Coma Scale and this information was of assistance to help your understanding. If you have any further questions, please feel free contacting me.

Sara Hance: 6:28

Thank you for tuning in to MEC Connect Expert Insights. Any further questions, please feel free contacting me. Thank you for tuning in to MEC Connect Expert Insights. Here at MEC, we focus on what matters most worker recovery and better claims outcomes. Our skilled people, proven processes and innovative technology achieve measurable results and creates lasting value. We hope you found Peggy's insights on the Glasgow Coma Scale valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you for listening.