Romanian Neurosurgery (Nov 2024)

MULTUM IN PARVO-THE GLASGOW COMA SCALE

  • Alexandru Vlad Ciurea,
  • Vicentiu Saceleanu,
  • Ovidiu Gramescu,
  • Dan Bentia,
  • Matei Serban

DOI
https://doi.org/10.33962/roneuro-2024-091
Journal volume & issue
Vol. 38, no. Special Issue

Abstract

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Introduction Coma assessment scales have been developed to facilitate ease of communication between emergency team members and to facilitate ease of clinical assessment for patients with severe impairment of consciousness. In 1974 Graham Teasdale and Bryan Jennett published in the Lancet a scale which theoretically helped physicians get a quick and accurate status of comatose patients. The scale they described assessed patient behaviour regarding three key aspects – motor reactivity, verbal communication and eye opening. As the two authors were working in Glasgow, the scale was dubbed the Glasgow Coma Scale (GCS) a name which all neurologists and neurosurgeons are well-accustomed with. Material The use of the GCS is based on the patient’s capacity to react using language and motion to external stimuli. Eye movement (1-4 points), Speech (1-5 points) and Motion (1-6 points) for a maximum total of 15 points or a minimum total of 3 points. A patient with a Glasgow Coma Score of 3 is completely non-reactive, while a patient with a Glasgow Coma Score of 15 is perfectly aware. This scale introduced in neurotrauma has simplified enormously the communication in neurosurgery, accompanying neurotrauma to the whole spectrum of neurosurgical pathology. Despite its wide use today, the GCS has been seriously criticised due to its incapacity to determine the functional status of brainstem structures. Therefore, various improvements and updates were performed for the Glasgow Coma Scale. Conclusions Over the years, the use of the GCS extended in the entire medical meme despite its criticism. The simplicity and ease of use which characterize the GCS made it a very useful instrument for neurological examination since the first moment a patient is seen by a medical professional. The Glasgow Coma Scale which recently reached its 50th birthday became a universal language for physicians. Since it has been in use neurological status can be expressed with great ease and without loss of meaning.

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