Trauma Scoring-Glasgow Coma Score (GSC)
Revised Trauma Score (RTS)
The American College of Surgeons Committee on Trauma recommends that patients with a GCS less than 14, or a systolic blood pressure less than 90, a respiratory rate greater than 29 or less that 10, or a Revised Trauma Score of 11 of less should be triaged to a trauma center, such as Wesley Medical Center.
The Glasgow Coma Scale and the Revised Trauma are two scoring systems that measure the acuity and severity of the patient's physiologic response to injury. In Sedgwick the Revised Trauma Score is used by pre-hospital personnel as one means of triage tool.
|Glasgow Coma Score|
|Eye Opening |
|Best Verbal Response||Best Motor Response|
|To Pain||2||Inappropriate Words||3||Flexion
|Apply this score to GCS portion of Trauma Score 3-15|
Pediatric GCS - Best Verbal Response < 2yrs. old
|5-||Smiles, orients to sound, interacts appropriately.|
|4-||Consolable cry. Aware of environment.
|3-||Inappropriate cry, persistent moaning.
|2-||Agitated, restless, inconsolable, cries. Unaware of environment.|
Revised Trauma Score (RTS)
|Glasgow Coma Scale (GCS)||13-15||
|Systolic Blood Pressure||90 mm Hg or greater||4|
|70-89 mm Hg||3|
|50-69 mm Hg||2|
|0-49 mm Hg||1|
Total Trauma Score
The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury. It is used primarily because it is simple, has a relatively high degree of inter observer reliability, and because it correlates well with outcome following severe brain injury.
It is easy to use, particularly if a form is used with a table similar to the one above. One determines the best eye opening response, the best verbal response, and the best motor response. The score represents the sum of the numeric scores of each of the categories.
There are limitations to its use. If the patient has an endotracheal tube in place, they cannot verbalize. For this reason, many clinicians prefer to document the score by its individual components; so a patient with a Glasgow Coma Score of 3 when intubated and paralyzed with a paralytic such as Norcuron, is not a valid indicator due to the chemically induced paralysis.
Other factors which alter the patients level of consciousness interfere with the scale's ability to accurately reflect the severity of a traumatic brain injury. So, shock, hypoxemia, drug use, alcohol intoxication, metabolic disturbances may alter the GCS independently of the brain injury. Obviously, a patient with a spinal cord injury will make the motor scale invalid, and severe orbital trauma may make eye opening impossible to assess. The GCS also has limited utility in children, particularly those less than 24-36 months. In spite of these limitations, it is quite useful and is far and away the most widely used scoring system used today to assess patients with traumatic brain injury.