What Is the Glasgow Coma Scale?

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What Is the Glasgow Coma Scale?

The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome following severe brain injury.

The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sports injury, for example, and in the emergency department and intensive care units.

The GCS measures the following functions:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to sound
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = orientated
  • 4 = confused
  • 3 = words, but not coherent
  • 2 = sounds, but no words
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = obeys command
  • 5 = localizing
  • 4 = normal flexion
  • 3 = abnormal flexion
  • 2 = extension
  • 1 = none
  • NT = not testable

Clinicians use this scale to rate the best eye opening response, the best verbal response, and the best motor response an individual makes. The final GCS score or grade is the sum of these numbers.

Using the Glasgow Coma Scale

A patient's Glasgow Coma Score (GCS) should be documented on a coma scale chart. This allows for improvement or deterioration in a patient's condition to be quickly and clearly communicated.

Individual elements, as well as the sum of the score, are important. The individual elements of a patient's GCS can be documented numerically (e.g. E2V4M6) as well as added together to give a total Coma Score (e.g E2V4M6 = 12). For example, a score may be expressed as GCS 12 = E2 V4 M6 at 4:32.

Every brain injury is different, but generally, brain injury is classified as:

  • Severe: GCS 8 or less
  • Moderate: GCS 9-12
  • Mild: GCS 13-15

Mild brain injuries can result in temporary or permanent neurological symptoms and neuroimaging tests such as CT scan or MRI may or may not show evidence of any damage.

Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills, and/or emotional/behavioral functioning.

Limitations of the Glasgow Coma Scale

Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the GCS.

Children and the Glasgow Coma Scale

The GCS is usually not used with children, especially those too young to have reliable language skills. The Pediatric Glasgow Coma Scale, or PGCS, a modification of the scale used on adults, is used instead. The PGCS still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together.

Here is the slightly altered grading scale for the PGCS:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to voice
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = smiles, oriented to sounds, follows objects, interacts
  • 4 = cries but consolable, inappropriate interactions
  • 3 = inconsistently inconsolable, moaning
  • 2 = inconsolable, agitated
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = moves spontaneously or purposefully
  • 5 = localizing (withdraws from touch)
  • 4 = normal flexion (withdraws to pain)
  • 3 = abnormal flexion (decorticate response)
  • 2 = extension (decerebrate response)
  • 1 = none
  • NT = not testable

Pediatric brain injuries are classified by severity using the same scoring levels as adults, i.e. 8 or lower reflecting the most severe, 9-12 being a moderate injury and 13-15 indicating a mild TBI. As in adults, moderate and severe injuries often result in significant long-term impairments.

Posted on BrainLine February 13, 2018. Reviewed July 25, 2018.

References

Teasdale G, Allen D, Brennan P, McElhinney E, Mackinnon L. The Glasgow Coma Scale: an update after 40 years. Nursing Times 2014; 110: 12-16

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. PMID 4136544.

The Glasgow Structured Approach to Assessment of the Glasgow Coma Scale. (n.d.). Retrieved February 13, 2018, from www.glasgowcomascale.org.

Comments (133)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Hello, i am medical student year 3 , how we want to assess blind people using glasgow coma scale

My husband was in a motorcycle accident, he was thrown from his bike he was not helmeted, he had gave his helmet to a passenger. Well he was GCS 3. The severity of his injury was so bad that he had 3 hemorrhages which was non-operable...He was on a ventilator I was told he could not breathe on his own, non reactive to light, pain stimuli, NOTHING. The neurologist advised us that his prognosis was very poor. He had 5CT Scans with no change. He was swelling on day 2, the family decided without me to take him off the ventilator.. they were advised he would not last no more than 30min but he held on for 9hrs BREATHING ON HIS OWN but gave up....I just got his medical records and read through them... he was intoxicated at the time of the accident, which could affect his tests etc. I believe if he lasted 9hrs before he passed, if they only left him on for a week to really see if there would be any changes, but because the swelling was so severe and they could not relieve the swelling the family decided to take him off. I’m more upset I wasn’t involved in that decision. Please have hope, trust your gut instinct because the doctors aren’t always right, they said my husband wouldn’t last 30min without the ventilator but he lasted 9hrs!!! I’m devastated my husband was only 34.

I will keep you in my prayers Rebekah. May you get the strength to overcome this grief. Please take good care of yourself. I am sure that wherever your husband is, he will always want you to take care of yourself and will be watching over you.
Stay safe.

How or why did the hospital let his family override you making that call to have him removed. You are his next of kin as long as you all were married.

My Gcs was a two when I had a grand Mal seizure do to alcohol - Aspirated as well. I survived it. How close was I to dead??

My father gcs is 4 after surgery before surgery it was 7. is there any chance recovery

So Jimmy Sham being GC15 is good and bad. Damn permanent neurological damage, I hope not.

To all the Doctors, nurses and anybody whatsoever connected with hospitals and the emergency services. For all of us you are our heroes because we all need you throughout life.

Thank you!

My grandmother gcs level is 3 is there is any chance for her to be normal?

That's pretty low, prognosis isn't good. Even an MD might say that. It all depends on the reason the GCS is so low...Stroke? Sepsis? No one can say much without the complete clinical picture. D. Gonzales RN

Hello! I don't know the extent of her injuries but, I was in a car accident almost 4 years ago and I believe my GCS score was 3-5, I was in a coma for 10 days and had paralysis on the right side of my body. Physically I have fully recovered, I had to relearn how to walk so I still have a very slight limp. However during my recent research of TBIs I have come to learn that TBIs start as acute (when they first happen) and turn into chronic TBIs (over time it becomes worse neurologically) as it turns into a chronic TBI, the psychological effects of the injury become worse due to the effect it has on the brains neurotransmitters. As far as I put together (I'm no doctor) my injury has effect on my serotonin, dopamine, and acetylcholine levels (probably effect other neurotransmitters, I have only researched these so far) and the TBI causes a deficit in these neurotransmitters. These deficits have caused a lack of motivation, sleeping all the time, memory, attention, learning and processing speeds, these are typical signs of depression, I am not sad, just experiencing symptoms of depression do to my brain injury affecting my neurotransmitters. From my research a SSRI and dopamine agonists/DARI (dopamine reuptake inhibitors) will help reduce these affects. I have yet to go to a psychologists to get these drugs. Do some research of how TBIs affect the neurotransmitters! She might not need them now but in a few years he might, definitely tell her or care giver to mention this to doctors, I waited 4 years to get help and my condition has only gotten worse, I can barely pass basic college classes now, with this information in her doctors hands can improve his doctors life! I've also read that Deep brain stimulation (DBS) can bring people out of vegetative states

Friend was A Glasgow 3, now Orthopedic surgeon.

From what I am reading, the **INITIAL** GCS Score has nothing to do with the chance of survival or quality of life. It is should be used only as a diagnosis tool that can show improvement or deterioration. Do I understand this correctly?

My friend, 23 years old, suffered a road traffic accident on 24 july 2019 (3 days ago).
His GCS is 6.
What are his chances of recovery?

It depends on various factors
Mri reports
Is he conscious or not
First 48-72 hrs are always critical in these kind of cases
If he shows progress in one or 2 days chances are he will recover

Hello! I don't know the extent of your friends injuries but, I was in a car accident almost 4 years ago and I believe my GCS score was 3-5, I was in a coma for 10 days and had paralysis on the right side of my body. Physically I have fully recovered, I had to relearn how to walk so I still have a very slight limp. However during my recent research of TBIs I have come to learn that TBIs start as acute (when they first happen) and turn into chronic TBIs (over time it becomes worse neurologically) as it turns into a chronic TBI, the psychological effects of the injury become worse due to the effect it has on the brains neurotransmitters. As far as I put together (I'm no doctor) my injury has effect on my serotonin, dopamine, and acetylcholine levels (probably effect other neurotransmitters, I have only researched these so far) and the TBI causes a deficit in these neurotransmitters. These deficits have caused a lack of motivation, sleeping all the time, memory, attention, learning and processing speeds, these are typical signs of depression, I am not sad, just experiencing symptoms of depression do to my brain injury affecting my neurotransmitters. From my research a SSRI and dopamine agonists/DARI (dopamine will help reduce these affects. I have yet to go to a psychologists to get these drugs. Do some research of how TBIs affect the neurotransmitters! Your friend might not need them now but in a few years he might, definitely tell your friend or his care giver to mention this to his doctors, I waited 4 years to get help and my condition has only gotten worse, I can barely pass basic college classes now, with this information in his doctors hands can improve his doctors life!

My friend's GCS is 3. And he is on ventilator. Doctors are saying that now they can't do anything. Only miracle can do. And if any miracle will happen even then also the patient will not be able to live his life outside the bed. Can any doctor here please suggest the next steps. To me or Doctors at the hospital. Thanks in Advance

My niece is in the same situation they have told us the same thing. Today makes 10 days in her coma shes showing no change shes still a 3.
What happened with your friend??

Hi. I am sorry for hearing that. The fact is we can not predict how a patient is going to evaluate. The GSC is just one of the parameters that us, doctors, use to have a better big picture of the patient’s general state. It will depend on what has caused it. The first 48 hours of evolution and so on. Actually GSC 3 is the minimal, so usually the prognosis is what we call “reserved”. I can’t not give any medical advice, just general information. There are a lot of more information that a doctor might know before giving a proper opinion. Wishing you the best. Claire

I'm Brian and I'm a survivor of a very serious football injury that left me in a coma for 5 weeks. I was a coma scale 3 myself!! I had a one percent chance of surviving myself! I have made a miraculous recovery but lost half of my vision and was parilized on my right side because I did suffer a stroke while I was in my coma. I had many years of intense therapies and my family has sacrificed so much for me! It's been very difficult but accepting new normal has been a very big challenge!! I hope ur friend has a good quality of life like I do!! I'm very lucky

When my daughter was 2 and a half, she drowned in a family pool. I found her, got her out and started CPR, while yelling for my grandpa to call 911. She was clinically dead. It was November and the water cold. Finally am heard and EMS called. I was only trained in basic CPR. I hadn't been taught this, but something told me to press on her belly and get the water out. I did and a lot of water came out, then I started CPR. I was doing it for maybe 7 minutes. In between a breath, I said," Breath Tracy breath". I swear right after I said that she started breathing, but it was erratic and sporadic. EMS arrived right after and took over. When I arrived at the hospital, I was told that she probably won't survive and even if she did, to tell my family that she wouldn't be the same little girl. I was asked if I wanted to donate her organs. I screamed at them that they're not cutting my baby. I prayed and called everyone I knew and asked them to do the same. In less than 24 hours, she walked out of the hospital, as if nothing happened. Now she's 20 years old and attending college. If, you didn't believe in miracles, you should now. My daughter is a miracle.

What an amazing story. God bless you and your daughter.

Good for you, that's what it comes down to in the end. Cold, dispassionate and sterile scientists, and some doctors who like to 'play god', versus actual god. Why do people take everything they say seriously anyway? Medical treatment has its place for sure, but its practitioners, particularly doctors and surgeons, don't need to be glorified and pandered to in the way they currently are. To see everything in purely mechanical, materialistic and physical terms is a disease in itself, a spiritual sickness. Good for you Rachelle; your faith saved your daughter and confounded the medics. I hope you and your daughter both live to see the future world.

Omg!! Rachelle I dont even know how I came upon this page...reading your story I was mortified all til the end, wow my heart was breaking for you, then I read where you say after praying, she began breathing !! Is God trying to tell me something ? My husband is currently in the hospital in a mental state of impairment due to passing out and staying unconscious for about 5 days until a well check was made by the local police only to find him almost dead. We are praying for a full mental recovery so he can be a part of our 9 yr old sons life!

Thank you for sharing your needs and I too happened onto this page, as I am recovering from a second TBI from precious, but careless distracted drivers. ❤️ I pray for them a lot. I’d like to apologize for typos as I’m experiencing a slight seizure as I write this, but felt compelled to do so.

Anyway I have experienced many miracles as we have a ministry specifically for the Deployed military members, and I have an Army soldier son of my own. He has been saved from death many times, and yet we have seen many who have fought just as hard and don’t always come home... but God sees the end, which is the Beginning. He sees what our hearts can fathom in such painful, tough situations, whether accidents, illnesses or war.

I’m praying wholeness and healing for those mentioned and you wonderful responders who made comments. I once was requested to go to Cedars-Mt.Sinai, on my way to visit my near to be son-in-law who had been so badly attacked he had Last Rites twice. On my way, I got a call (I’m a non-denominal minister) to pray for a little girl who drowned in my friend’s pool states away. She was in a vegetative state and in full convulsions 24/7. I remember nurses weren’t happy with me when I asked to see her, per her parents request. They just wanted others to let her die peacefully, and felt we were nuts quite frankly. I went into room, tried not to let her string convulsions dampen my faith and prayed. Nothing happened that I could see change. I told the Lord it is up to Him and I’d stand. Nothing happened until hours later that night. I traveled a lot and My friend did not let me know till much later that after I left Elisha suddenly awoke! Fully healed and yes, a miracle. My soon to be son in law was hooked up to countless machines in a catholic Tarzana hospital when I arrived, near LA. Half his head was crushed. Swollen to where I could not tell who he was. Drs said No Hope. I asked his mom in my first level Spanish to come sit by me as I prayed. And prayed. For three days. On the third day I laid my hand beside his, not on it and felt I was to call his name and ask him to squeeze my hand on his own if he could. Immediately to our shock, he grabbed my hand hard and I still have the picture! He slowly improved to a fairly independent state, though not quite the same. It turned out to be as God saw fit, as He sees the whole picture. We never do. I speak hope to you for the impossible. Wisdom for the choices you must make. God’s presence to surround and draw each of you so close you feel it in your heart. I’ve been around for a long time. I’ve seen soldiers and all Kinds of diverse folks seeming fine one moment and when all alone, take their own lives. And I’ve heard military and non-military families were told fellow ministers had left scenes and preached sermons to them Saying their child was in hell. Mortal sin. I do not believe that is scriptural nor do I see such a limited God that He doesn’t hear our last cries. Even if silent. He alone knows the hearts of those who could not hold on. I expect to see them in heaven someday at least I’m praying each one will be!

But for all of us still on this side of the “veil”, battered, depressed or feeling our lives don’t mean much in our condition, we are still here, so we must fight...and when we can’t, we must ask those we love and most of all our God, By His Spirit, to hold our hand through the hard journey whether loved ones live or pass on. But one more word. Talk to them. They often hear everything. Don't just “kick it” yakking or speaking bad outcomes. They “hear.” Speak life until the Master lets their work continue or He sees fit to bring them home. God bless each of you! HOOAH! I’m sorry I was so wordy. I’ll blame it on the rants that comes with TBI’S.
LW.

It's very good to hear tht ur daughter is fyn.
.

Wow- amazing story! God Blessed you

I had a severe brain injury during brain surgery in 1998 that had left me with a bad sleeping disorder and short-term memory loss. I was in a coma for a month and paralyzed on my right side and I didn't know who I was or anyone in my family. I had to go through all of the therapy to learn how to walk, talk, get dressed, everything all over again. I will always have my disabilities but I'm a fighter and I have God on my side to help me. I was only 22 years old but like I said I'm a fighter and I will always be. :)

God is amazing! He works miracles all the time!

Glad to hear your daughter is OK now.

Glad it turn out good. You saved her with CPR. I have to remember push on the belly.

helo...my father is suffering from SUB dural hemorrhage problm.he was operated by the doctor.after operate 10 day he will fine .but now he can't speak clear word all.whoever want to speak is not able to speak clear.understand everything but have difficulty speaking plz rply me fast gcs 15 /15

Hi . its been about 9 years since. I had a brain trauma. My right side of the brain was struck by A bullet at slow speed and its been in my brain . I was awake the whole way to the hospital. I called my parents informing them on the situation.. When o arrived to the ER. I was thinking I'd ne VfB er. Wake up from surgery. I told My parents good bye just. In case I'd never wake up. I di wake up 2 days. Later with a draining straw from my head and a bag of blood. The doctors decided to leave. The bullet inside since. I had been responsive . until now I havbent suffered of much just some medium headaces . I jger worried at times that I'll die soon because of the lead . I feel OK I guess . and Mainly I feel happy for getting a second chance in living my life.

Hi, my daughter was in a RTA in Sept 2016, she was hit by a van that mounted the pavement when walking home from school. She was two doors from home, she was airlifted to Alder Hey hospital in Liverpool thank God. Her GCS was 3 and was 5 days in a coma, she is doing well and is attending college soon to go to university. Yes miracles do happen, the treating brain surgeon later told me she didn't think she would survive.

My husband was in a head-on collision a little over a week ago. his face was fractured to the point that it caved in all the way to his brain cavity. his GCS number at the moment is an eleven. they have already begun his facial reconstruction and cleaning off his brain. I need to know if any one else has experienced anything similar to his story. and what are the chances of a full recovery? we have four children and I am in fact worry to death about the possibility of him being violent and how I would address it.

My husband was in a head on RTA - serious injuries leg/arm/hand scar under chin, coma. He is fine now apart from arthritis developing over the years. Believe it or not, some slivers of glass still work their way through the scar on his head! Apart from not remembering anything about an hour prior to the accident and on waking he is OK.
His friend was killed outright, so we count our blessings. His coma lasted approx 10 days. God Bless you & your familyx

Hello there,
It is so difficult to know what the outcome will be in any brain injury as everyone is different and without looking at the MRI/CT Brain scan it is almost impossible to predict. The Frontal lobe is responsible for Personality, behavior and emotions so if there was any damage to this part of the brain, those functions may be affected.
I would echo the previous responder with recommending plenty of neuro rehabilitation and neuropsychological support. In my experience isolated violence and aggression is unusual. the best advice is to keep having regular updates with his neurology team.

hope this helps

Please, in lay terms what does this really mean 'neuro rehabilitation and neuropsychological support'.

Hi Jay- I hope you happen to visit back and see this. I just happened to see your post when showing someone this page. I'm so sorry about your husband's accident & sure you're all terrified. I'll say that 5 years ago I suffered a brain aneurysm that hemorrhaged and caused me to fall and I suffered a TBI. When I was in a coma for 5 days after my emergency neurosurgery I had a GCS rating of 5. So hopefully your husbands brain has fared better than mine. But my tips would be therapy & Lots of it, specifically cognitive behavioral therapy, traumatic brain injury rehab and lots of love and patience. Knowing that he may never be the same but he may well be better in some ways. I say better b/c everything in his life will be examined and appreciated now. Of course I'm only speaking from my experience. But there can never be enough patience or therapy. This will take time but things will heal.

My mother is 81 years old and was brought to the local hospital after she had a fall due to acute pain in her back. This morning, she lost consciousness after she was given the wrong combination of analgesic and morphine. The doctor himself admitted to an error in the dosage administered to alleviate the pain, which seems to have caused her to fall into a deep coma. Her Glasgow score is 5.This happened in France and I live in Ireland, so I'm in shock at the thought of a medical error being the cause of my mum's deep coma. Any thoughts on this would be very appreciated as I'm wondering what to do.

Hi i am kriti from nepal..
I need to know that why '0' ranking is not given in GCS scale??
Thank you

searching for the same answer

Gcs scale are calculateed by adding eye response , verbal response and motar response. Now if person's all these responses are negligible, these are given as 1, and 1+1+1=3.. so minimum score is 3.

It's because the scale goes from 3 - 15. If the eyes are not opening to anything (+1 point), the person is not speaking (+1 point) and not moving (+1 point). That adds up to 3 points.

0 means the pt is dead

Hi,

my 72-year-old dear grandfather fell down in a shop, still due to unknown reasons though the doctors think it was syncope, and unfortunately, damaged he hit with his head so hard he now has several contusions on his brain. A bit after the fall, he was concious and was speaking a few words, but later on everything got worse. He is now in intensive care, especially because he had a kidney transplantation five months ago. At first, he could not recognise us, he could not speak and was, of course, sleeping all the time. Now, after 10 days, he says a few understandable words, has moments of clarity when he recognises us and express a little smile to see us, but then he gets lost, confused and almost looks like he is halucinating. His motor skills are good, but I’m concerned about the emotional and cognitive recovery. What could we expect?

Thanks!

I was out with some friends drinking and got a GCS of 8, body temp of 34 and was unconscious for 7 hours. i was discharged 2 hours after i woke up and was 17 at the time. would this be a coma or what

My friend, 57 years old, suffered a road traffic accident on 2 Feb 2019 (yesterday).
His GCS is 4.
What are his chances of recovery?

In this day and age, I would guess good. if they had the Glasgow when I had my head injury in 1970, I would of been a 3. There weren't such things as speech therapy etc. back then to help recover. Hard to tell what symptoms I suffered as was very traumatic for the whole family, so not many facts remembered. I was unconscious 5 days. Hard to tell who and what I may have been without the head injury, but I am alive and breathing and functional 49 years later. I think it probably depends where the injury was and whether is was an open or closed wound. The swelling of my brain in my case, was directed in my eye, it was the size of a softball. Injury was in the frontal lobe. Just depends on many factors.

I was in a coma in 2014. I don't know what my score was but i believe it was low. They gave me a 1% chance of survival, and b4 reaching family, had already contacted the science institute to donate my body. How can i find out what my score was?

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