Glasgow Coma Scale

The Glasgow Coma Scale (GCS) is a neurological assessment tool used to evaluate a patient’s level of consciousness and neurological functioning.

The GCS consists of three components: eye opening, verbal response, and motor response, with each component being assigned a score. The scores from these three components are then added together to obtain the total GCS score, which can range from 3 to 15. A higher score indicates a higher level of consciousness and neurological function.

GCS Components and Scoring

Component	Score	Description
Eye Opening
Spontaneous	4	The patient opens their eyes without stimulation.
To voice	3	The patient opens their eyes in response to verbal commands.
To pain	2	The patient opens their eyes in response to painful stimuli, such as a pinch.
None	1	The patient does not open their eyes in response to any stimuli.
Verbal Response
Oriented	5	The patient responds coherently and appropriately to questions.
Confused conversation	4	The patient responds but is disoriented and may have a conversation that does not make sense.
Inappropriate words	3	The patient uses words, but they are unrelated or inappropriate.
Incomprehensible	2	The patient makes sounds, but they are not recognizable as words.
None	1	The patient does not produce any verbal response.
Motor Response
Obeys commands	6	The patient follows commands, such as “squeeze my hand” or “raise your arm.”
Localizes pain	5	The patient withdraws or localizes in response to pain, such as moving the arm away from a painful stimulus.
Flexion withdrawal	4	The patient flexes their limbs in response to pain but does not localize it.
Abnormal flexion	3	The patient exhibits abnormal flexion in response to pain (decorticate posturing).
Extension	2	The patient displays extension of limbs in response to pain (decerebrate posturing).
None	1	The patient does not exhibit any motor response.

Assessing the Glasgow Coma Scale

To assess a patient’s GCS score, follow these steps:

1. Eye Opening: Determine the patient’s response to stimuli and assign the corresponding score: 4 for spontaneous, 3 for response to voice, 2 for response to pain, or 1 for no response.

2. Verbal Response: Assess the patient’s verbal interactions and assign the appropriate score: 5 for oriented, 4 for confused conversation, 3 for inappropriate words, 2 for incomprehensible sounds, or 1 for no verbal response.

3. Motor Response: Observe the patient’s motor reactions to stimuli and assign the relevant score: 6 for obeying commands, 5 for localizing pain, 4 for flexion withdrawal, 3 for abnormal flexion, 2 for extension, or 1 for no motor response.

4. Add the scores from each component together to calculate the total GCS score, which can range from 3 (indicating severe impairment) to 15 (indicating normal neurological function).

The GCS is a valuable tool for assessing and monitoring patients with neurological conditions or head injuries, helping healthcare providers make informed decisions about patient care and treatment. It provides a standardized way to communicate a patient’s level of consciousness and is often used in emergency medicine, intensive care, and neurology.