Disorders of Consciousness
809
2. To stratify the severity of head injury (mild: GCS = 13 – 15, moder-
ate: GCS = 9 – 12, severe: GCS
≤
8 ) (25,26).
3. To identify candidates for intubation; i.e., airway protective reflexes
are typically defective at a GCS
≤
8, which is used as an indication
for endotracheal intubation.
4. As a prognostic marker; e.g., in the initial evaluation of nontraumat-
ic coma, patients with a GCS
≥
6 are seven-times more likely to
awaken within two weeks than patients with a GCS
≤
5 (27).
5. The influence of induced hypothermia on the prognostic value of
the GCS is described in Chapter 17 (see Table 17.5).
INTUBATED PATIENTS:
One of the major shortcomings of the Glasgow
Coma Scale is the inability to evaluate verbal responses in intubated
patients. These patients are assigned a verbal pseudoscore of 1 (for a
maximum GCS of 11).
Oculocephalic Reflex
Oculovestibular Reflex
Present
Absent
Present
Absent
Brainstem Intact
Brainstem Not Intact
FIGURE 44.3
The ocular reflexes in the evaluation of coma.
