Sam’s medical status:
There is a measurement that is given to people with a coma called the Glasgow Coma Scale (GCS). The scale is a little confusing at first because it starts at 3 for the worst case and goes to 15 which is the best. There are three criteria that are used: Eye response, verbal response and motor response. Even when a person has the lowest responses, they are at a “3” which is the total of the three categories I just mentioned–“1” being the lowest score possible for each category.
When Sam arrived in Germany, he was given a GCS score of 3 or 4. Obviously that was devastating to all of us when we heard that and the GCS score system was explained to us. Someone with an 8 or lower is said to only have a 50% chance of living. A score of 8 or less is also said to be “critical”. 9-11 is considered “moderate” and greater than 12 is a minor injury.
The GCS score is derived from adding up the three categories Eye response, Verbal response and Motor response. Usually the score is broken down using all three categories, so as an example, a score of 11 (see table below) could be derived from the following:
E (eye response) = 4 points
V (verbal response) = 1 points
M (motor response) = 6 point
Now that I’ve given you more information about the Glasgow Coma Scale than you’ve ever wanted to know, let me tell you the good news!
Sam’s GCS is now at a 10! I don’t have the actual breakdown of the Eye, Verbal, Motor responses from Erin (she’s trying to get them) but I believe the scores are what I just mentioned above with E4 and M6. Because Sam is still intubated, the official “V” medical response would be “Vintubated”, so I’m assuming that is the reason he is not an 11 or greater. He’s not going to have the tracheotomy tube removed until he’s in Palo Alto, so who knows?—maybe he can talk, but just can’t right now because of the tracheotomy tube. That means his GCS may be even higher!
Glasgow Coma Scale Breakdown: Here’s some more information on the Glasgow Coma Scale. Hopefully it will increase your understanding and not confuse you any further:
1 The Glasgow Coma Scale provides a score in the range 3-15; patients with 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. For adults the scores are as follows:
|Eye Opening Response||Spontaneous—open with blinking at baseline||4 points|
|Opens to verbal command, speech, or shout||3 points|
|Opens to pain, not applied to face||2 points|
|Verbal Response||Oriented||5 points|
|Confused conversation, but able to answer questions||4 points|
|Inappropriate responses, word discernible||3 points|
|Incomprehensible speech||2 points|
|Motor Response||Obeys commands for movement||6 points|
|Purposeful movement to painful stimulus||5 points|
|Withdraws from pain||4 points|
|Abnormal (spastic) flexion, decorticate posture||3 points|
|Extensor (rigid) response, decerebrate posture||2 points|
2E + V + M = 3 to 15
90% less than or equal to 8 are in coma
Greater than or equal to 9 not in coma
8 is the critical score
Less than or equal to 8 at 6 hours – 50% die
9-11 = moderate severity
Greater than or equal to 12 = minor injury
1 © Russ Rowlett and the University of North Carolina at Chapel Hill
2 © 2006 CNS. All rights reserved