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 (95)

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.

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

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

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?

Hello Andrea,

You can obtain your medical records and the score should be documented there.

~Melody

My father is from one week in coma now and he is in scale under 8 of coma..he fell in coma by a blood pressure and he opens his eyes or moves his legs or mouth unconsciously.. for how long he can stay in this condition?

how is your father now?

My brother been in an accident and he got gcs of 5 due to brain injury . He is on life support and we are scared whether anyone experienced and what are the hopes?

My mum just got stroke at cerebellum and Stem My dad immediately sent her to the hospital on around 4 am on 29th August 2018 . When my mum arrived to the hospital she was still conscious and spoke out with my aunt.

After, she was done surgery and opened the skull out. She kinda in coma but still good at motor, eyes movement, and verbal. However, on Saturday night her score of EVM was dropped and the doctor decided to gave her a melting blood medicines. On the Sunday morning, she was sent to CT scan again and the result is she has bleeding at left side of thalamus around 1.4 cm. , oval size shape. This is why it's made her score dropped. Now, on 4th September 2018, her EVM score is 5-6 and still stable, her blood pressure and heart rate are 138/80 and 68-90. I am believe it's will be better and better soon. I have HOPE!! and I believe in my mum. She is very healthy person, don't have any personal diseases. Moreover, the doctor said my mum worst than last Saturday but still stable and he will send my mum for CT scan in this two up coming day.

My mom had a right side stroke 20 days back it was a big area but only affected her left hand after 7 days in icu she had a cardiac arrest too and it took10 mins to revive her after that she was in coma for 4 days shw can’t move her body or follow us with eyes but sometimes I feel she could hear me n feel my presence ct scan showed that her brain edema is almost gone I’m so worried afraid she never wake up or walk because of this stroke she can’t do MRI due to her pace maker does anyone here had the same problem ?

My daughter, her friend and my ex husband were all in an MVA, all had GCS 3 on scene. My 17 year old daughter died in the ambulance, her friend was in a coma for 2 weeks and has mostly recovered physically and my ex husband was in a coma for a month has physical limitations but seems to be pretty good in regards to his brain injury, so one never knows how anyone's story will turn out. Keep hoping but also understand the reality of such a trauma.

Thank you for your very straight and realistic delivery of what happened to your loved ones. I cannot imagine how bad it must hurt your soul.,but I can thank you for being clear and understandable for me,during a very traumatic time for me as well. God bless you, and again Thank you for the realization that none of it makes sense, it just is.

Daisy, I do not know you but am saddened at the loss of your daughter. May God be with you as you travel this path.

My friend a 51 year old fit man was working away in Nigeria and collapsed 11 days ago. He had a carotid artery aneursym and underwent surgery 3 days later. It appears he suffered a "small" stroke during the surgery and has since been at GCS of 4 now 8 days postop. Difficult for me as I am in the UK x

My niece had a very serious accident where she was hit by a car.She had severe head injury and is currently lying in ICU unit. Have not woken up since the last 3 days. What are her chances of recovering.

I was in an accident where I lost my motor skills, I was unable to speak, drool was falling out of my mouth, and tears and mucus from my nose was free running.  In the Call type: Stoke/CVA, yet in the Glasglow Coma Score I was given a perfect 15, which is healthy.  Also, the narrative was incorrect, people who worked in a business helped me into a chair and then into their business, EMS were at the scene before HPD and the narrative states HPD moved me into the business.  The narrative said that I "stated", I could make some words, but not sentences.  None of this is reflected in the report and therefore not at all helpful with litigation.  Just because what you see written as your score, doesn't mean it is true or accurate.  I was defenseless and helpless, unable to speak or think clearly enough to check what EMS and HPD wrote.  HPD also said that I "stated", he got the information from a witness who helped me into the business.  Technically all helpful, in that I was provided aid, but all the detail are wrong.  If EMS was evaluating me for a stroke, how could I speak.

To the person who described having an accident after falling asleep at the wheel (the post was on Nov.3, 2016 at 1:46 a.m.), it is clear from your post that you are facing both the realities and "what-ifs" of your accident.  Doing that much emotional work many hours each day (you were up at 1:46 a.m.) must be exhausting. I feel compassion for the part of your experience that isn't under your control - - for example, how your family has reacted. That may or may not be yours to fix.  Family dynamics are often very complex, even under the best of circumstances. And you're not in the best of circumstances. 

My career of nearly 25 years has been working with acutely ill and actively dying patients and their loved ones. It has been my experience that critical and life-threatening illness ( especially involving a loved one in a coma) can bring out either the best or the worst in families. And sometimes it takes surviving the "worst" before you ever get to the "best". I wonder if your emotional perceptions of their behavior towards you has completely recovered? And how did you feel about your place in the family before you had your accident. Only you can answer both of those questions.  Having a mental health professional or a Minister you trust might help you find your "new" emotional self and establish more stability in your own self judgment. No amount of time or recovery or reflection can change what happened so you might further your progress of recovery by staying in your own present life.

I really recommend that you talk to your Primary Physician about how you can have a solid, good night's sleep more days of the week.  The hours of 1:00 a.m.- 4:00 a.m. can distort our thinking and those can be very lonely hours, as well.  Please forgive yourself first for what you truly are accountable for and then forgive those you feel have abandoned you. They probably haven't... and I'm accepting that each person who grows up in a difficult family environment is seen through that same filter until they choose not to be vulnerable to it.

Wishing you continual recovery and hour-by-hour progress each day.

mjl, San Diego

I am not the person you were replying to, but your words are true and helpful. Thank you.

I am a brain injury survivor. On January 13 2015 I was diagnosed with a GCS grade of five. Now I am working on my driving. My wife accidently picked the correct place. She chose  a place called Pate all because there was a donkey on the brochure.  I will be forever grateful to her for this. Well to start off I was on my way to work and some lady tried to pass two cars, and hit me in the driver's door which flipped my explorer over on to its roof.  Well of course she walked away no problem. I took a helicopter ride that I didn't sign up for. I thank God that they came so quickly. I plan on thanking all of them for that. Here at Pate they take care of you. I'm actually writing this on Pate's computer. My wife made a wise choice. I wouldn't be as far along without their help. They have helped me out a lot! If it was up to my insurance  They would have sent me to a nursing home. I wouldn't even be writing you this if I was in a nursing home. I wouldn't even be able to to tell you what the date is! Overall I have gone to the right place. God has a way where everything works out. To be honest I wasn't a believer in God until this happened. 

To go on I have use in my left hand now. I can do all kinds of things using my left hand. Typing this for instance is a huge accomplishment. Before, I would say that I can not do it. Now I think that the sky is the limit. There is nothing that I can't do. If you ever have a brain injury, there is nothing you can't do. I believe that you can do anything that you put your mind to.

2 years ago I suffered a brain stem stroke and was a 3. I was 33 years old.  Here I am typing this to you . Miracles happen everyday 

Hi, can you tell me about your brain stem stroke?
We are facing it with my brother. Apparently no hope..
Thank you

my grandson was in a car accident 12-20-15, he has a tramatic brain injury and he also had a stroke...l think his GCS score would be a 7or8  hes been in a vegetative state since - are there any success stories out there of any kind?    hes only 17....its been almost a year and a half...we have tried fish oil - and ambien - with no luck...we would do anything to help him.....l just dont know what to do.......l dont know what to hope for - l dont know what to pray for.....he is suffering...SUFFERING - GOD HELP ME

I wish the same, my little boy has been in a coma for nearly 3 years now. Miracles do happen and blessed are we that they are so young and recovery is higher for them. I will be praying for him if you would pray for my boy <3 thank you.

Go to TIRR in Houston

I had a GCS of 3 in 2001-Thanks 1st to God; then to the paramedics and trauma team at Memorial Hermann and TiRR; I have done a nurse refresher; several half marathons; a sprint triathlon and am back to LIFE! * There IS HOPE!*

?Thank you all for sharing your stories.  God Bless you all.

30 years ago, I was 25 and was in an accident that resulted in TBI, and close head trauma.  I was an elite athlete and this happened going home from a training ride.

I had an Out of Body Experience at the scene.

I was GCS 3 for days, then a 4, and came out of my 'coma' on day 11.  I was given a 6% chance of survival and when my family all gathered from out of town- they were mainly concerned with consent for me to be an Organ donor.  

After 6 weeks total of therapy, etc.  They let me go home.

Well, I'm still here, have a profession, family, but, 30 years later it still haunts me.  I think about some aspect of this traumatic accident EVERY DAY!

Stay Strong my friends,

Todd Bouton, MS, PA-C

Todd_Sails AT yahoo.com

Thank you so much for sharing!!!!!!!! God bless you

I was in a motorcycle accident 9/08/07. Glasco scale of 3, in coma for a month. Went to rehab where I was taught to eat, get out of bed, dress, etc. I am now on my own, but am getting along. I have to keep my life simple but am doing ok with paying bills. I don't have social skills and do not leave my home often. Let people know they can get better but they will have some drastic changes.
My son had a gcs score of 3 , he survived, but has a severe brain injury, he can talk , walk short distances , he was on life support for 19 days, he is now a year and half since the high powered car accident he is violent, rude and like a 3 year old but he survived

My nephew fell down from the motobike on last Sunday. He did not get any significant injury looking from outside. His safety helmet was not seriously damaged. But his GCS is 3. Doctors say there is no hope. But I am hoping and we will fight against destiny until a miracle happens as what you here got it. Thank you for your stories.

I had a gcs of 3 when I had my brain aneurysm.
Neurosurgeon, told my parents I'd properly need 24 hour care if I lived but within 3 months I was back at work and back to normal.
Wishing him all the best x

I am so so sorry for what u are going through. I was just looking this up and came across your comment. It’s Heartbreaking. I’ve been through a lot with my fiancé these past few months but it makes it so much worse when it’s a child. I am hoping he is ok and will keep you both in my thoughts!!

My son was ruled a 3 by one paramedic and a 5 (3 on pain response) by another following a self-inflicted gunshot wound to the head. He was found about 15 minutes later and immediately flown to a large trauma center and evaluated by a trauma surgeon and a neurosurgeon. There was nothing they could do and he was placed in the neuro ICU unit and pronounced brain dead 12 hours later. The pathologist said he never felt a thing, but the score of a 5 makes me wonder if he was having a response to a sterna rub that he felt pain in his head. I'm hoping he felt nothing after the shot, but I just don't know.

I want to know if my brother would be able to survive. He has 9/15.

Thank you so very much for sharing your story. I just got back from visiting my sister who had a GCS of 2.5 upon arrival. Day 25 still in coma and on ventilator I was looking to see when or if she will wake

I was a level 3 for a couple of weeks after being run over by a car in a hit and run in Glasgow this year. Broken skull, subarachnoid brain hemorrhage, collapsed lungs and other broken bones. Doctors, consultants and the police do not know how i survived. I am now disabled with brain type disability but can almost function the same as i could before the accident. Recovery from this may take months/years. But it is possible.

Hi
So sorry to hear your story. The exact same has happened to my uncle who had just been given scale 5. We're heart broken. I hope he pulls through like you have. Xxx

8/2/09 I had a bad accident and I was a 4 when they found me. I was very tired and I rested my eyes and fell right to sleep. I do still have cognitive and emotional/behavior problems, but everyday is a new day. I am having a hard time forgiving myself because my life has completely changed. Although, I did just start college Aug. 15th of this year and even though I have cried about just about everyday ,I am still pushing through. My family backed away from me. They were there for me in the beginning but as soon as I looked just fine and because they thought I was talking just fine that I was healed. And stupidly I had a drug experience for about a year because I fell for a man that just wanted my pain medicine and then I really lost my family. Please, If your loved one has a MTBI or a TBI don't leave them alone. I have thought about suicide many of times, and 9/28/15 I came very close. My organs were even failing. Still while I was in the hospital for a month after no one in my family came to see me or even called. I do deal with major pain as well because the left side of my pelvis broke off and shattered. I also broke my sacrum as well as different areas in my pelvic ring. My family had it hard when I was growing up because my mother was very mentally ill and always looked for attention. And that is what my family is judging me on. I thank the lord that I am still here and definitely do have hope in your loved one. Miracles do happen and with the help of the nurses and doctors who do care I thank you very much. You are even a major part of why I'm still here. I know how hard it is for me yet alone someone who would be a caregiver or loved on of someone who has had this happen. Just know even if they talk just fine and look just fine, that is not the truth. God bless anyone in this situation. Mine could have been so much worse but I am very lucky. It's amazing to me that I'm even writing this post today because even 3 years ago I wouldn't have emotionally been able to. I have teared up but I am not crying. Also, pray. prayers do work and God is listening. I did not have health insurance when this happen on 8/2, but on 8/7 I was approved for health insurance that started 8/1. My writing teacher would be pretty upset because of the way I wrote this but I just wrote from my heart. I was 27 when this happened and almost athletic and they said that was why I even survived. I didn't have my seat belt on and I kicked my shoes under the pedals and even said to myself is there really even a god... I remembered this after I think 2-3 months later. And I was also blessed that I didn't wear my seatbelt that night or because of the way my car crushed around and knocked out the palm tree, I heard roots and all, I would be paralyzed or it would definitely been fatal if I wasn't ejected. Now that doesn't mean don't wear your seat belt. It means do not rest your eyes, and I have talked to many whom said they have and asked them to please never do that again. I made sure there were no other cars on the road but I didn't think about myself. If you are tired, pull over and call someone or take a nap. And make sure you tell your loved ones every chance you get that you love them. This happened in seconds. God bless you all!

Very good and hopeful information on recovery from DAI

My daughter scored 3 on the GCS for 4 weeks, she now can talk and eat properly and we're working on walking. Without hope, you have nothing.

hello , my friend is in hospital for last 8 days because of edema (blood clotting ) at brain stem as he has high blood pressure. initially he has a gcs level 4 & after 4 days he has gcs of 5 for a day only. But now he has (4/5). so is there any time limit that gcs should increase unless it will never increase?

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