The scale was originally developed for patients with Head injuries (HI), with typically more diffuse rather than focal neurological deficits.
In patients with aphasia the verbal score produces an unrepresentative assessment of their conscious level, therefore a totally aphasic patient would have a maximum score of 10 (rather than 15). This represents damage to the speech and language centre rather than decreased consciousness.
Identification of the best motor response is done by comparing the movements of each arm, therefore the non-hemiparetic limb should be used for assessing the motor response in the GCS. A painful stimulus must never be applied to a hemiplegic limb in patients who are awake and aware.
Factors that interfere with the assessment process in each category of the GCS. When interfering factors are present, the score should be recorded as ‘not testable’ (NT) for the relevant category of the GCS, e.g. if the patient has endotracheal tube, tracheostomy or swelling of eyes this should now be recorded NT (Not testable to record missing component). However, the overall trend demonstrated by the GCS within each of the 3 sections scores – eye opening, verbal response and motor response can inform clinical decisions and has clinical value.
Note: Click here for video link which provides a practical guide to carrying out and recording the 3 aspects of GCS assessment.
Page last reviewed: 04 Mar 2021
