The Glasgow Coma Score (GCS) was developed in the 1970s initially as a research tool for admitted Neurosurgery patients. The original authors of the score and research advocated against it’s widespread use in acute care but nevertheless here we are: it is widely used in acute trauma and medical care.
Other than a score of 3 or a score of 15, there are multiple combinations of numbers that can get you various scores. This results in a poor ability to know what the patient is actually doing. The same combined score can represent two very different patients making the score difficult to interpret:
| Patient 1 GCS = 10 | Patient 2 GCS = 10 |
Eyes | 4 = spontaneous | 2 = open to pain |
Verbal | 5 = oriented | 3 = inappropriate words |
Motor | 1 = No response | 5 = localizes to pain |
Which patient above are you more worried about?
There is some rationale to use GCS as triage tool for trauma center vs not:
GCS <13 –> level 1 (or highest available trauma center in your system)
GCS > 13 –> can go to lower level trauma center (if they don’t otherwise meet other system criteria for a level 1 trauma center)
In fact the most recent American College of Surgeons (the major trauma surgery body in the USA) field triage criteria have moved on to using a motor-GCS or M-GCS only:
M-GCS <6 –> level 1 (or highest available trauma center in your system)
M-GCS = 6 –> can go to lower level trauma center (if they don’t otherwise meet other system criteria for a level 1 trauma center):