Welcome back! In this episode, we’re diving deep into something we all think we know, the Glasgow Coma Scale.

The GCS has been a fundamental part of assessing patients with altered consciousness for over 50 years. You’ll find it in trauma scores, neurology exams and practically every prehospital and ED handover. But here’s the thing, is it as reliable and useful as we think?

In this episode, we’ll explore the origins of the scale, what it was designed for and how it’s been used (and maybe misused…) since. We take a look at how reproducible it really is, particularly when different clinicians score the same patient. Spoiler alert: it’s not always as consistent as you might hope!

We’ll also unpack the individual components; eyes, voice, motor and ask if they all carry equal weight, or are some more prognostically useful than others? Because a GCS of 4 isn’t always the same GCS of 4, depending on how you get there…

We’ll be looking at real-world implications, how we make decisions around airway management, imaging, and referral, all based on that one number.

So whether you’re in prehospital care, the ED, or intensive care – stick with us as we try to answer the question: is the GCS still doing what we need it to, or is it time to move on?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

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References

A practical review of the Glasgow Coma Scale and Score. Barlow. The Surgeon. 2012

50 Years of the Glasgow Coma Scale: A historical perspective. Wells. Journal of Clinical Neuroscience. 2025

Interrater reliability of Glasgow Coma Scale scores in the emergency department. Gill. Annals Emergency Med. 2004

Interrater Reliability of Four Neurological Scales for Patients Presenting to the Emergency Department. Haldar. Indian Journal of Critical Care Medicine. 2020

Interrater reliability of the Glasgow coma scale scoring among nurses in sub-specialties of critical care. Heron. Australian Critical Care. 2001

Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Fischer. Critical Care. 2010

Assessment of Coma and Impaired Consciousness: A Practical Scale. Teasdale. Lancet. 1974

Improving the Glasgow Coma Scale score: motor score alone is a better predictor. Healey. J Trauma. 2003

Goodbye GCS. Mark Wilson. ICN

Consciousness: Its Neurobiology and the Major Classes of Impairment. Goldfine. Neurol Clin. 2011

Duncan R, Thakore S. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009

Rotheray KR, Cheung PS, Cheung CS, et al. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?. Resuscitation. 2012

Moulton C, Pennycook A, Makower R. Relation between Glasgow coma scale and the gag reflex. BMJ. 1991

Kulig K, Rumack BH, Rosen P. Gag reflex in assessing level of consciousness. Lancet. 1982

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning. Freund. JAMA. 2023

Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments: A quantitative systematic review. Brun. Australian Crit Care. 2025

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