Glasgow Coma Scale
The GCS has found wide clinical application since it was first published in 1974 (48). It rates a person's verbal, motor, and eye-opening responses on a scale of 3 to 15. It has the advantages of being simple, having a relatively high degree of interobserver reliability, and the ability to be determined shortly after injury (49).
A score of 8 or less is considered to be coma and classified as severe injury, 9-11 as moderate injury, and 12-15 as mild injury. There have been studies that indicate that a GCS score of 5 or lower instead of 8 or lower should be considered as severe injury in children, as scores lower than 5 have been associated with a good outcome (12,50-52). Although the GCS was initially formulated to aid in acute triage and in neurosurgical management, many studies have correlated outcome with initial scores. There is, however, wide patient-to-patient variability. Some have noted that the GCS in the field is more predictive of survival (13,53), and GCS later in the post-injury course (particularly the motor component at 72 hours after injury) is a better predictor of disability (13,53). Adaptations of the GCS have been made to facilitate evaluation of children (54,55). Other refinements of the scale include the number of days until a patient returns to a GCS of 6 or 15.
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