The Glasgow Coma Scale (GCS): Deciphering the Motor Component of the GCS

The Glasgow Coma Scale (GCS) was developed to standardize the assessment of neurologically compromised patients, to assist in triaging severity of injury, and to direct management decisions for an individualized plan of care. This examination allows for frequent assessments to ascertain worsening of neurological symptoms that would warrant additional radiological scans or interventions. The GCS score is composed of three components: eye, verbal, and motor, with motor being the most difficult to assess. A need for clarification of the motor component of the GCS was identified in a neurotrauma intensive care unit (ICU) at a level 1 hospital in the United States. The aim of this article is to illustrate the need for clear, common language to describe the patient's motor response to a painful stimulus post head injury, to avoid communication breakdown between healthcare professionals. Proper training and understanding of the components of the GCS, particularly the motor component, will lead to proper use of the scale and thus clearer communication among healthcare professionals. Pre- and post-GCS training tests were administered during educational sessions, with demographics collected. A focus of training was on the motor component of the GCS. A multiple-choice selection included all motor score choices. Tests were de-identified with a matching number to calculate prescoring and postscoring. Of the 54 nurses tested, 50% incorrectly completed the pretest, of which 37% had ≥5 years ICU experience. Moreover, 93% of the posttests were correct. Further evaluation is required to assess accuracy of communicating examination findings to physicians and documentation in the electronic record.