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Glasgow Coma Scale

Glasgow Coma Scale (GCS)

Assesses level of consciousness in patients with brain injury

All tools /

Glasgow Coma Scale

Glasgow Coma Scale (GCS)

Assesses level of consciousness in patients with brain injury

Overview

When to use

Why use

Evidences

Interpretation:

The Glasgow Coma Score is calculated by adding the points assigned to each of the three response categories: eye opening, verbal response, and motor response. The total score is expressed as a single value, such as “15 points”, which helps assess the level of consciousness in a patient.

The Glasgow Coma Scale (GCS) refers to the individual scores within each component, shown separately as E(3), V(4), M(5). This format provides a detailed view of the patient’s neurological status.

Component	Response	Point
Eye	Opens spontaneously	4
	Opens on command	3
	Open in response to pain	2
	No opening at all	1
	Not Testable*	NT
Verbal	Fully oriented	5
	Confused	4
	Inappropriate responses to questions	3
	Incomprehensible sounds or noises	2
	No verbal response	1
	Not Testable*	NT
Motor	Follow all instructions	6
	Move away if pressure is applied	5
	Move away as a reflex	4
	Flexion in response to pressure	3
	Extension in response to pressure	2
	No movement at all	1
	Not Testable*	NT

*Some components of the Glasgow Coma Scale may be untestable due to specific clinical factors. While not exhaustive, the following are common examples:

Eye Response: May be untestable due to local injury or periorbital swelling (edema).
Verbal Response: May be affected by intubation or other airway interventions.

All Components (Eye, Verbal, Motor): Sedation, paralysis, or mechanical ventilation may prevent any observable responses.

The GCS was introduced in 1974 and is now included in trauma and critical care guidelines worldwide. Its adoption is supported by decades of clinical use and research demonstrating its value for evaluating patients with traumatic brain injury and impaired consciousness. It is embedded in key scoring systems such as APACHE II and SOFA, required by the NIH Common Data Elements, and recognized in the ICD-11.
Research confirms the GCS's high interrater reliability and strong predictive value for outcomes in adults with head injuries. Peer-reviewed studies and systematic reviews underline the scale's robustness for acute neurological assessment, triage, and monitoring. It is also incorporated in the World Federation of Neurosurgical Societies grading for subarachnoid hemorrhage.

https://www.ncbi.nlm.nih.gov/books/NBK513298/

The GCS is highlighted in U.S. resources from the CDC and NIH as the central tool for assessing brain injury severity. These organizations provide educational materials to guide best practices in trauma and emergency settings.

https://www.cdc.gov/traumatic-brain-injury/

https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi

Overview

When to use

Why use

Evidences

The Glasgow Coma Scale, first introduced in 1974, remains one of the most widely used methods to evaluate levels of consciousness in patients with neurological compromise. It is particularly valuable in emergency and critical care environments where fast, objective assessment is needed.

The scale serves multiple clinical purposes:

Determines severity of traumatic brain injuries (TBI)
Aids decisions about intubation and airway protection
Helps monitor progression or deterioration of a patient’s condition
Supports triage and referrals to neurosurgery or intensive care

The GCS is universally accepted in trauma protocols and is included in pre-hospital assessments by EMS, in-hospital monitoring by nurses and physicians and during post-operative neurological checks. A GCS score of 8 or below is commonly associated with severe brain injury and may indicate the need for mechanical ventilation or neurosurgical evaluation.

Routine use of GCS improves inter professional communication, documentation accuracy and care planning. It is a key element of protocols for stroke, seizures, trauma and coma management.

Overview

When to use

Why use

Evidences

Interpretation:

Component	Response	Point
Eye	Opens spontaneously	4
	Opens on command	3
	Open in response to pain	2
	No opening at all	1
	Not Testable*	NT
Verbal	Fully oriented	5
	Confused	4
	Inappropriate responses to questions	3
	Incomprehensible sounds or noises	2
	No verbal response	1
	Not Testable*	NT
Motor	Follow all instructions	6
	Move away if pressure is applied	5
	Move away as a reflex	4
	Flexion in response to pressure	3
	Extension in response to pressure	2
	No movement at all	1
	Not Testable*	NT

*Some components of the Glasgow Coma Scale may be untestable due to specific clinical factors. While not exhaustive, the following are common examples:

Eye Response: May be untestable due to local injury or periorbital swelling (edema).
Verbal Response: May be affected by intubation or other airway interventions.

All Components (Eye, Verbal, Motor): Sedation, paralysis, or mechanical ventilation may prevent any observable responses.

The GCS was introduced in 1974 and is now included in trauma and critical care guidelines worldwide. Its adoption is supported by decades of clinical use and research demonstrating its value for evaluating patients with traumatic brain injury and impaired consciousness. It is embedded in key scoring systems such as APACHE II and SOFA, required by the NIH Common Data Elements, and recognized in the ICD-11.
Research confirms the GCS's high interrater reliability and strong predictive value for outcomes in adults with head injuries. Peer-reviewed studies and systematic reviews underline the scale's robustness for acute neurological assessment, triage, and monitoring. It is also incorporated in the World Federation of Neurosurgical Societies grading for subarachnoid hemorrhage.

https://www.ncbi.nlm.nih.gov/books/NBK513298/

https://www.cdc.gov/traumatic-brain-injury/

https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi

Frequently Asked Questions

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