What is the Glasgow Coma Scale (GCS)?

The Glasgow Coma Scale (GCS) is a clinical tool used to objectively assess a patient's level of consciousness and neurological functioning after a brain injury. It evaluates three aspects of responsiveness: eye opening, verbal response, and motor response. Scores range from 3 to 15, with lower scores indicating more severe impairment.

How is the GCS Score Calculated?

The GCS score is the sum of three components: Eye Opening (E), ranging from 1 (no eye opening) to 4 (spontaneous eye opening), Verbal Response (V), from 1 (no verbal response) to 5 (oriented), and Motor Response (M), from 1 (no motor response) to 6 (obeys commands). The total score is calculated as E + V + M.

ADDONS / SCALES

Glasgow Coma Scale (GCS)

David Goldemund M.D.
Updated on 23/07/2024, published on 20/02/2024

Glasgow Coma Scale (GCS) is an objective and reliable tool for assessing patients´ level of consciousness based on their response to defined stimuli; it is used in acute medical and trauma patients
GCS evaluates three aspects of responsiveness: eye-opening (E), verbal response (V), and motor response (M)
- interfering factors must be considered (intubated or aphasic patients, factors such as sedation, alcohol or drug influence)
stimulation used:
- sound: spoken or shouted request
- physical: pressure applied to the fingertip, trapezius, or supraorbital notch
score the highest observed response
the GCS has been incorporated into numerous clinical guidelines and scoring systems
- in the setting of head trauma, a GCS score of ≤ 8 on admission represents severe traumatic brain injury (TBI)
scores range from 3 to 15, with a normal finding being GCS 15 (E4V5M6)

→ Disorders of consciousness

GCS-P score

in 2018, an updated version of the GCS called the “GCS-P” was published (the P stands for “pupil”) (Brennan, 2018)
this is a fourth number that providers subtract from the standard GCS score ⇒ GCS-P score can range from 1 to 15
- a GCS score of 3 and a pupil score of 2 is a GCS-P score of 1; that means a very deep coma with no pupil reaction in both eyes)
the pupil scores mean:
- 2 = neither pupil reacts to light
- 1 = one pupil doesn’t react to light
- 0 = both pupils react to light
GCS-P 1 and 2 extend the information about injury severity
the GCS-P score still uses a score of 8 or fewer to mean a coma

Glasgow Coma Scale (GCS 3-15)
Eye-opening
4	spontaneous
3	response to a verbal command
2	response to pain/pressure
1	none (eyes don’t open for any reason)
Verbal response
5	oriented (oriented; correctly gives name, place, and date)
4	confused (not orientated but communicating coherently)
3	inappropriate words (single intelligible words)
2	incomprehensible sounds (moans/groans only)
1	no verbal response
Motor response
6	obeys commands
5	localizes pain (targeted defense reaction)
4	reflex withdrawal from pain
3	decorticate posturing – arms are flexed at the elbows and held inward and close to the body; the legs and feet are extended and turned inward
2	decerebrate posturing – rigidity with arm and leg extension, wrist flexion, and foot plantar flexion → Decorticate and decerebrate posturing
1	no motor response