Glasgow Coma Scale
Score eye, verbal and motor response using the 2014 structured criteria.
Report the components, not just the sum: E4V5M6
The Glasgow Coma Scale rates conscious level on three responses: eye opening out of 4, verbal out of 5 and motor out of 6. The total runs from 3 to 15, and a patient scoring E3 V4 M5 has a GCS of 12 — the moderate band. Always report the three parts, not only the sum.
Three responses, scored separately
The scale was published by Teasdale and Jennett in 1974 to replace vague descriptions such as “drowsy” or “stuporous” with something two observers could agree on. It works by recording the strongest response the patient gives in each of three domains — whether the eyes open, what sounds or words come out, and what the limbs do — against a defined stimulus.
Because a patient cannot score below 1 in any domain, the minimum total is 3, not 0. There is no such thing as a GCS of 0: a patient with no response at all scores E1 V1 M1, totalling 3.
Report the components, not just the total
A total of 9 can describe very different patients. E2 V2 M5 and E4 V1 M4 both come to 9, but the first is opening eyes only to pressure while localising, and the second is awake-eyed with no speech and only withdrawal. The 2014 structured update stresses reporting the three figures — written E3 V4 M5 — precisely so this information survives handover. Where a component cannot be assessed, because of swelling or an endotracheal tube, it is recorded as not testable rather than scored 1.
- 1 Check, observe, stimulate, rate — in that order. First check for anything that interferes with a response, then observe spontaneous behaviour before applying any stimulus.
- 2 Score eye opening out of 4. Open before any stimulus is 4, to a spoken or shouted request 3, to fingertip pressure 2, and never 1.
- 3 Score the verbal response out of 5. Correct name, place and date is 5; coherent but disorientated 4; single words 3; moans or groans 2; nothing audible 1.
- 4 Score the motor response out of 6. Obeying commands is 6, localising to the stimulus 5, normal withdrawal 4, abnormal flexion 3, extension 2, no movement 1.
- 5 Add the three and report all four numbers. E3 + V4 + M5 gives a total of 12, recorded as E3 V4 M5 = 12 so the pattern is not lost.
The 2014 structured criteria
The best response observed in each domain is the one scored; in the motor domain, the best response in any limb.
| Score | Eye opening | Verbal response | Motor response |
|---|---|---|---|
| 6 | — | — | Obeys commands |
| 5 | — | Orientated | Localising to pressure |
| 4 | Spontaneous | Confused | Normal flexion (withdrawal) |
| 3 | To sound | Words | Abnormal flexion |
| 2 | To pressure | Sounds | Extension |
| 1 | None | None | None |
How the total is banded
Bands describe the severity of a traumatic brain injury; they are a summary, not a diagnosis.
| Total | Band |
|---|---|
| 13–15 | Mild |
| 9–12 | Moderate |
| 3–8 | Severe |
What shifts a score without the brain changing
Several things confound the scale. Sedation, paralysing agents, alcohol and hypoglycaemia all depress responses; an intubated patient cannot produce a verbal score at all; severe facial swelling can close the eyes mechanically. None of these mean the brain injury has worsened, which is why the structured approach begins by checking for interfering factors before anything is scored.
The trend is also more informative than any single reading. A falling total, and particularly a falling motor score, is the change that matters, so serial observations are recorded together. Scoring, interpretation, and any escalation belong to a qualified professional working to local protocol.