Glasgow Coma Scale

グラスゴー・コーマ・スケール GCS

WordNet

1. take by attacking with scaling ladders; "The troops scaled the walls of the fort"
2. a specialized leaf or bract that protects a bud or catkin (同)scale leaf
3. an ordered reference standard; "judging on a scale of 1 to 10" (同)scale of measurement, graduated table, ordered series
4. relative magnitude; "they entertained on a grand scale"
5. size or measure according to a scale; "This model must be scaled down"
6. the ratio between the size of something and a representation of it; "the scale of the map"; "the scale of the model"
7. a measuring instrument for weighing; shows amount of mass (同)weighing machine
8. a flattened rigid plate forming part of the body covering of many animals
9. an indicator having a graduated sequence of marks
10. (music) a series of notes differing in pitch according to a specific scheme (usually within an octave) (同)musical scale
11. a thin flake of dead epidermis shed from the surface of the skin (同)scurf, exfoliation
12. remove the scales from; "scale fish" (同)descale
13. reach the highest point of; "We scaled the Mont Blanc" (同)surmount
14. climb up by means of a ladder
15. measure by or as if by a scale; "This bike scales only 25 pounds"
16. measure with or as if with scales; "scale the gold"
17. pattern, make, regulate, set, measure, or estimate according to some rate or standard
18. (botany) a usually terminal tuft of bracts (as in the pineapple) or tuft of hairs (especially on certain seeds)
19. a state of deep and often prolonged unconsciousness; usually the result of disease or injury (同)comatoseness
20. (astronomy) the luminous cloud of particles surrounding the frozen nucleus of a comet; forms as the comet approaches the sun and is warmed
21. largest city in Scotland; a port on the Clyde in west central Scotland; one of the great shipbuilding centers of the world

PrepTutorEJDIC

1. 《しばしば複数形で》『てんびん』,はかり / てんびんのさら / 《重量を表す副詞[句]を伴って》…の目方(体重)がある / …‘を'てんびんではかる
2. (蛇・魚類などの)うろこ / うろこ状の物;(ペンキ・さび・ふけなどの)爆片 / 〈魚など〉‘の'うろこを取る;…‘の'皮をはぐ / (…から)〈ペンキなどの薄泰〉‘を'そぎ取る《+『名』+『off』(『from』)+『名』》 / (…から)〈ペンキなどが〉かげ落ちる《+『off』(『from』)+『名』》
3. 『段階』,等級,階級 / 『比率』,縮尺 / (物差しなどの)『目盛り』 / (目盛りの付いた)『物差し』;温度計,(各種の)スケール / 『規模』,スケール / 音階 / 記数法,…進法 / …‘を'よじ登る / (…に合わせて)…‘を'調整する《+『名』+『to』+『名』》 / …‘を'縮尺で製図(設計)する
4. こん睡状態
5. コマ(彗星(すいせい)の核の周囲の星雲状物質) / (レンズの)非対称収差 / (種子の)種綿(たねわた)
6. グラスゴー(Scotland南西部の港市)
7. cobaltの化学記号

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/27 07:24:59」(JST)

wiki ja

[Wiki ja表示]

Glasgow Coma Scale(GCS)（グラスゴー・コーマ・スケール）とは、1974年に英国のグラスゴー大学によって発表された意識障害の分類で、現在世界的に広く使用されるの評価分類スケールである。日本では主に脳神経外科領域で用いられることが多い。開眼・言語・運動の3分野に分けて記録し、意識状態を簡潔かつ的確に記録できる。

なお、GCSが発表された後、エディンバラ大学は対抗してEdinburgh Coma Scaleを発表した。しかしながらそれを使用したのはエディンバラ大学に関係する医師に限られ、結局GCSが世界的に広がることとなった。

Glasgow Coma Scale

記述は、「E　点、V　点、M　点、合計　点」と表現される。正常は15点満点で深昏睡は3点。点数は小さいほど重症である。

開眼機能(Eye opening)「E」

• 4点：自発的に、またはふつうの呼びかけで開眼
• 3点：強く呼びかけると開眼
• 2点：痛み刺激で開眼
• 1点：痛み刺激でも開眼しない

言語機能(Verbal response)「V」

• 5点：見当識が保たれている
• 4点：会話は成立するが見当識が混乱
• 3点：発語はみられるが会話は成立しない
• 2点：意味のない発声
• 1点：発語みられず

なお、挿管などで発声が出来ない場合は「T」と表記する。 扱いは1点と同等である。

運動機能(Motor response)「M」

• 6点：命令に従って四肢を動かす
• 5点：痛み刺激に対して手で払いのける
• 4点：指への痛み刺激に対して四肢を引っ込める
• 3点：痛み刺激に対して緩徐な屈曲運動（除皮質姿勢）
• 2点：痛み刺激に対して緩徐な伸展運動（除脳姿勢）
• 1点：運動みられず

日本では、簡便なJapan Coma Scale(JCS)が広く用いられている。

関連項目

• 意識障害
• 脳死
• 切迫するD

wiki en

[Wiki en表示]

Not to be confused with Glasgow Outcome Scale.

The Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).

GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, nurses and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital.

GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system, as it was designed for. The initial indication for use of the GCS was serial assessments of patients with traumatic brain injury and coma for at least 6 hours in the neurosurgical ICU setting, though it is commonly used throughout hospital departments. A similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients.

Elements of the scale

Glasgow Coma Scale

	1	2	3	4	5	6
Eye	Does not open eyes	Opens eyes in response to painful stimuli	Opens eyes in response to voice	Opens eyes spontaneously	N/A	N/A
Verbal	Makes no sounds	Incomprehensible sounds	Utters inappropriate words	Confused, disoriented	Oriented, converses normally	N/A
Motor	Makes no movements	Extension to painful stimuli (decerebrate response)	Abnormal flexion to painful stimuli (decorticate response)	Flexion / Withdrawal to painful stimuli	Localizes painful stimuli	Obeys commands

Note that a motor response in any limb is acceptable. The scale is composed of three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Eye response (E)

There are four grades starting with the most severe:

1. No eye opening
2. Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the patient's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).
3. Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
4. Eyes opening spontaneously

Verbal response (V)

There are five grades starting with the most severe:

1. No verbal response
2. Incomprehensible sounds. (Moaning but no words.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
5. Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Motor response (M)

There are six grades:

1. No motor response
2. Decerebrate posturing accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot)
3. Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot)
4. Withdrawal from pain (Absence of abnormal posturing; unable to lift hand past chin with supra-orbital pain but does pull away when nailbed is pinched)
5. Localizes to pain (Purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supra-orbital pressure applied.)
6. Obeys commands (The patient does simple things as asked.)

Interpretation

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35".

Generally, brain injury is classified as:

• Severe, with GCS < 8–9
• Moderate, GCS 8 or 9–12 (controversial)
• Minor, GCS ≥ 13.

Generally when a patient is in a decline of their GCS score, the nurse or medical staff should assess the cranial nerves and determine which of the twelve have been affected.

Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached e.g. "E1c" where "c" = closed, or "V1t" where t = tube. A composite might be "GCS 5tc". This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for "abnormal flexion". Often the 1 is left out, so the scale reads Ec or Vt.

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently the Pediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.

Revisions

• Glasgow Coma Scale: While the 15-point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14-point scale, omitting the category of "abnormal flexion". Some centres still use this older scale, but most (including the Glasgow unit where the original work was done) have adopted the modified one.
• The Rappaport Coma/Near Coma Scale made other changes.
• Meredith W., Rutledge R, Fakhry SM, EMery S, Kromhout-Schiro S have proposed calculating the verbal score based on the measurable eye and motor responses.
• The most widespread revision has been the Simplified Motor and Verbal Scales which shorten the respective sections of the GCS without loss of accuracy.

Controversy

The GCS has come under pressure from some researchers who take issue with the scale's poor inter-rater reliability and lack of prognostic utility. Although there is no agreed-upon alternative, newer scores such as the Simplified motor scale and FOUR score have also been developed as improvements to the GCS. Although the inter-rater reliability of these newer scores has been slightly higher than that of the GCS, they have not gained consensus as replacements.

See also

• AVPU scale
• Blantyre Coma Scale
• Early warning score
• Paediatric Glasgow Coma Scale
• Rancho Los Amigos Scale
• Revised Trauma Score
• Triage

References

• Teasdale G, Jennett B (1974). "Assessment of coma and impaired consciousness: A practical scale". The Lancet 2 (7872): 81–4. doi:10.1016/S0140-6736(74)91639-0. PMID 4136544. 
• Teasdale G, Murray G, Parker L, Jennett B (1979). "Adding up the Glasgow Coma Score". Acta Neurochir Suppl (Wien) 28 (1): 13–6. doi:10.1007/978-3-7091-4088-8_2. PMID 290137. 
• Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S. (1998). "The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores". J Trauma 44 (5): 839–44; discussion 844–5. doi:10.1097/00005373-199805000-00016. PMID 9603086. 

External links

• Website to calculate the Glasgow Coma Scale
• Glasgow Coma Scale Calculator
• Glasgow Coma Scale at the US National Library of Medicine Medical Subject Headings (MeSH)
• An Android app to calculate GCS / PGCS
• Dr. Graham Teasdale speaks with The Lancet - podcast, August 2014
• Glasgow Coma Scale at 40
• Simplified Motor Score

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における昏迷および昏睡 stupor and coma in adults
• 2. 小児における外傷の分類 classification of trauma in children
• 3. くも膜下出血の重症度分類 subarachnoid hemorrhage grading scales
• 4. 小児における重度の外傷性脳損傷に対する初期アプローチ initial approach to severe traumatic brain injury in children
• 5. 急性重度外傷性脳損傷のマネージメント management of acute severe traumatic brain injury

English Journal

• Terson haemorrhage in patients suffering aneurysmal subarachnoid haemorrhage: A prospective analysis of 60 consecutive patients.

• Stienen MN, Lücke S, Gautschi OP, Harders A.SourceDepartment of Neurosurgery, University Hospital Bochum-Langendreer, In der Schornau 23-25, 44892 Bochum-Langendreer, Germany; Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007 St. Gallen, Switzerland.
• Clinical neurology and neurosurgery.Clin Neurol Neurosurg.2012 Jul;114(6):535-8. Epub 2012 Apr 1.
• OBJECTIVE: The concomitance of vitreous/subhyaloid haemorrhage (Terson syndrome; TS) and aneurysmal subarachnoid haemorrhage (aSAH) is commonly underestimated. The aim of this study was to determine the incidence of TS and to identify parameters that predispose its development, indicate the severity
• PMID 22472353

• Outcome prediction by amplitude-integrated EEG in adults with hypoxic ischemic encephalopathy.

• Tian G, Qin K, Wu YM, Ji Z, Wang JX, Pan SY.SourceDepartment of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
• Clinical neurology and neurosurgery.Clin Neurol Neurosurg.2012 Jul;114(6):585-9. Epub 2011 Dec 27.
• INTRODUCTION: Amplitude-integrated electroencephalography (aEEG) had been widely used in predicting outcome in infants with hypoxic ischemic encephalopathy (HIE). We aimed to evaluate the use of aEEG as a quantitative predictor of outcome in adult patients with HIE.METHODS: aEEG and Glasgow coma sca
• PMID 22206857

Japanese Journal

• Nationwide Survey of Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction in Japan

• Suyama Kazuhiko,Horie Nobutaka,Hayashi Kentaro,Nagata Izumi
• World Neurosurgery 82(6), 1158-1163, 2014-12
• … The end points included 30-day mortality rate and functional outcomes, as measured according to the modified Rankin scale (mRS) score at 3 months.Results Three hundred fifty-five patients underwent DHC at 259 neurosurgical departments who replied to the survey, corresponding to a rate of 8.7% of the 4092 candidates with malignant MCA infarction, the latter being equivalent to 8.5% of patients with acute ischemic stroke identified during the same period. …
• NAID 120005526597

• 心原性心停止 (特集 救急蘇生における心拍再開後ケアの実際) -- (心拍再開後ケアの実際)

• 花田 裕之
• 救急医学 = The Japanese journal of acute medicine 38(5), 542-544, 2014-05
• NAID 40020093677

• 両側の血腫除去術を要した頭部外傷8症例の臨床的検討

• 大渕 英徳,萩原 信司,菊池 麻美 [他],高橋 祐一,吉村 知香,横佐古 卓,新井 直幸,黒井 康博,広田 健吾,笹原 篤,谷 茂,糟谷 英俊
• 東京女子医科大学雑誌 84(1), 9-12, 2014-02-25
• … 来院時意識レベルはGlasgow Coma Scaleで7が1例、6が1例、5が1例、4が2例、3が3例で、全例重症頭部外傷だった。 … 転帰はGlasgow Outcome Scaleで4例がDead、2例がSevere disability、2例がModerate disabilityで,Good recovery症例は存在しなかった。 …
• NAID 110009676512

Related Links

• Glasgow Coma Scale

40th anniversary of the Glasgow Coma Scale ... Glasgow Coma Scale The Glasgow Coma Scale provides a practical method for assessment of impairment of conscious level in response to defined stimuli.

• Glasgow Coma Scaleとは - goo Wikipedia (ウィキペディア)

The Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria ...

Related Pictures

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「グラスゴー・コーマ・スケール」

　　[★]

英

Glasgow Coma Scale Glasgow coma scale GCS

同

グラスゴー昏睡尺度

関

日本昏睡尺度

概念

• 意識障害の評価法の一つ。
• イギリスで作成された。
• 15点満点で、最小が3点。
• 軽症障害の分類が細かいとされる。

• 脳血管障害にはJCS
• 外傷にはGCS。

GCS

	開眼		言葉による応答		運動による応答
	eye opening		best verbal response		best motor response
6					命令に従う	obeying
5			指南力良好	orientated	払いのける	localication
4	自発的に	spontaneous	会話困難	confused conversation	四肢の屈曲	withdraws
3	言葉により	to speech	不適当な言葉	inappropriate words	四肢の異常屈曲	abnormal flexion
2	痛み刺激により	to pain	意味不明の声	incomprehensible sounds	四肢伸展	extending
1	開眼しない	none	発話せず	none	全くなし	none

評価

• 15点：意識清明
• 13～15点(3)：軽症
• 9～12点(4)：中等症
• 　～ 8点 ：重症
• 　　　3点：最も状態がわるい。

• GCS8点以下では意識低下とみなす。
• 頭部外傷でGCS8点以下は重症
• GCS8点以下 あるいは GCSスコアで2点以上の急激な悪化・瞳孔不同・片麻痺がある場合には切迫脳ヘルニアであることが多い。(重症頭部外傷治療・管理のガイドライン 第2版)
• GCS8点以下の重度意識障害、急速な意識レベルの低下、脳ヘルニア徴候を認めた場合にはsecondary surveyの最初でCTを撮影。(重症頭部外傷治療・管理のガイドライン 第2版)
• GCSスコア8以下、あるいはFCSスコアの最良運動反応が5以下であれば気管挿管を原則とした確実な気道確保が望ましい。(重症頭部外傷治療・管理のガイドライン 第2版)

「GCS」

　　[★] グラスゴー・コーマ・スケール Glasgow Coma Scale

「scale」

　　[★]

• n.

• 1. (魚・は虫類の)うろこ。(チョウ・ガの)鱗粉。(皮膚の)鱗屑。薄片。(植物)芽鱗、鱗片。(動物)カイガラムシ。(金属を熱したときにできる)薄い酸化膜、スケール。(ボイラーややかんの内側にできる)湯垢。歯石。
• 2. 目盛り、定規、物差し、尺度、基準。(地図などの)縮尺比、縮尺目盛り。階級、等級。規模、スケール
• 3. はかり、てんびん

• vt.
• vi.

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「Co」

　　[★] コバルト cobalt