What Is the Glasgow Coma Scale?

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What Is the Glasgow Coma Scale?
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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 June 8, 2022.

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 (193)

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.

Anonymous replied on

Our son Cody has a TBI he was sent to nursing homes instead of therapy right out of the hospital. He has been neglected no for four years by staff. We have to beg them to get him up in a jerry chair. So we can take him out side he loves that. The are not trained to get him better. My wife is with him every day since day one. I am with him WED and THURSDAYS. They will not move his arms and legs to make him better. He laughs with us is trying to talk. Following everything with his eyes. We would love to get a new Glasgow score. We know he is making great advance but no one cares. HELP what do we do where can we go. He’s on medicaid. This Nursing home is his 6th attempt to get him help. They just take the medicaids money and do nothing for him to get better. We have a camera in his room. And when the nursing home gets approval for 20 hours they take the cash and don’t do the Care.

Anonymous replied on

My nephew got in a car accident in FL in Aug he been in a coma ever since he was at three different hospitals now they said his insurance won't cover him no more he trys to talk he squeezes your hand to answer yes and no questions but now I'm afraid he is gonna be that way forever because we don't know what to do

Anonymous replied on

23 years ago I was in a car collision which almost turned fatal. I was ejected from my car, which landed on me and drug me 25 - 30 feet. Airbags were used to lift the car off of me. I was rushed to the local hospital where my daughter was delivered by emergency c-section. We were then air lifted to separate hospitals in Phoenix, AZ. I sustained a TBI and my Glasgow score was 1. I was comatose for 1 month and hospitalized for 3.5 months. My daughter was hospitalized for 1 month.
With intense therapy I regained my abilities. My daughter was handicapped but is a happy girl. I also have earned an Associate of Applied Science, a Bachelors and Masters of Science in Accounting. God is so good!!!

Anabel replied on

Wow that is such an amazing story god bless you.

Anonymous replied on

My brother was in a recent fall related accident and has currently been non-responsive for almost a week. Prognosis is not good, but I am just trying to understand what I can, since I cannot be there in person.

Auska replied on

I overdosed on my meds on purpose as a way to end my life in February because so many people have created the "Us and Them" scenario between me and my fiancé, she had to choose all of her friends and family or me, her fiancé. I didn't want to have her have to make such a horrible choice nor did I want to be alive for all of the poor treatment everyone was giving me or deciding to leave her so she could have her family and friends back, so I OD'd on my seizure rescue med. When I was at the hospital, I slid into a coma at 6 on the scale. They told my fiancé that it was very unlikely I'd make it at all since almost nobody survives a benzodiazepine overdose. They decided without calling my fiancé to pull my plug the next day and I died off life support and I had to be brought back to life. My fiancé demanded I be put back on life support, so I was. I woke up the next day in spite of the fact that I had barely any chance to survive. Since then I've been more short-fused, and irritable and I have really bad memory now but I'm getting my memories back by writing an autobiography to try and jumpstart my memory.

Kris replied on

My heart goes out to you and I hope life has improved for you

SG replied on

I had a GCS of 15 but from what my mom estimates based on it, I probably was a 10. I was in a bus accident going 50 and we were hit head on by a car going 90-100+. In the ER which I don't remember at all, they asked me my name and it took me a few minutes, and I could not remember the year or president.

Looking back, I should have been sent to Cooper Trauma in Camden or CHOP in Philly. I had a stroke about 4 days later, it was mild thank god, but still, I was 15.

Anonymous replied on

I had a GCS of 3 for 2 weeks, then periods of agitation as became slowly more aware, then a presumed delirium with fluctuating GCS.
Having a brain injury/Coma is survivable, anyone with concerns about their selves or a loved one in this situation please try and be optimistic, I know that's easy to say and hard to do.
I consider myself very lucky even having some minor disabilities now, I have little bit of trouble with concentration and memory and toes on left foot being numb and my right leg is numb from the hip down and I have to wear a splint from knee down. But that being said I consider myself lucky, I spent 3 months in hospital, 2 of which were in stroke/brain injury rehabilitation, and some of my fellow patients on ward had bigger hills to climb than me.
Extremely humbling,
Think the point I'm trying to make is "where there's life there's hope" We have some wonderful health care workers who don't get the acclimation they deserve sometimes. They saved my life, and I wish the best to anyone who is in this situation, be it their selves or a loved one.

Jess replied on

Thank you for posting your story.

Cintia - SLP replied on

Thank you very much for sharing with us your experience. It is always very helpful to hear from someone else how they have experienced a brain injury in first hand. Thank you :)

Anonymous replied on

what is GCS in confusion ?

Rhiannon replied on

If eye opening and motor skills are normal it'll be a 14. E4V4M6.

Jan Khan replied on

Dear My czn is toom accident that date 9 almost done 5 days and his scale is 7 and he is 26 years old can anyone tell me its possible to recovers thanks

Shannon L Blackham replied on

I scored a 3. So, yes, it is extremely possible

Ashlee replied on

Hi Jan.
yes of course there is recovery possibility.
For example I’m now 29, however in February last year. I was placed in an induced coma for 2 days and has d. A GCS score of 3 and I’m completely fine(for me lol)

I wish your family all the best xx

Anonymous replied on

of course he can recover. Is he in treatment at the moment

Anonymous replied on

GCS means Glasgow Coma Scale

Anonymous replied on

Reading through these comments bring back so much pain, I just lost my dad to a horrible car accident. He lost control of his vehicle and suffered many injuries, his whole left side of his brain had a stroke, he literally started swelling within 24hrs of his car accident. His GCS score was 3 and writhing the days of him being in the trauma center he was not on any sedation and his score remained a 3. I hate thinking that drs did not do everything in their power to save him. He was so young and it hurts so bad, I guess I just hate knowing that a lot of my family members who I have lost have died in that hospital. I don’t even know what to think! I just can’t come to terms with it, I kept telling the drs on face time. Please do everything you can for him! Remember to you he is just a check, you will have another case today tomm the next but to me that is my dad a brother a grandpa a husband. I guess it was just so hard because through the entire process because of covid we were not allowed to be by his side. We only got one hr one hr before he passed.

Rose replied on

Dear anonymous,
May God help your heart heal from this experience. Hold on to the wonderful memories of your dad, allow yourself to forgive what may or may not have been done right at the time. Your dad and the rest of your relatives who have passed on are free of pain now. May they continue to rest in peace. sending you a big hug of comfort

Valerie replied on

I am so very sorry to hear this , I wish you peace and love

maryiam replied on

hi. sorry to hear that and i hope better days for you and the loved ones. her in Iran we have great and good doctors who are very kind and of course they are highly able in terms of medical knowledge and operations.

Rose replied on

I am so very sorry to hear of your dad's accident and his death. May he rest in peace and may you and your family find peace also.

Yawanga replied on

Oh, My Lordness...!
May his soul be rest in enternal.

Dr.Nseka replied on

Thanks be to God..
Amen

Dawn replied on

My brother-in-law has a GSC of 5 and has been between a 3-5 for 8 days. He was found unconscious for unknown amount of time with fever of 108. He is in acute renal failure, on a ventilator, no sedation, and still unresponsive. They said his crit level is a 7 and climbing and want to start dialysis. Not sure he will pull thru with a constant GSC of 5 of 8 days. Any feedback? He is a drug addict and did have meth laced with fentanyl in his system.

Anonymous replied on

I was in a bad car wreck going 65mph in a head on collision in Alaska. I didn’t hit my head on anything but I was shaken very badly (only know this because the seat belt locked so tight that it almost cut me in half but wouldve been thrown and died if I wasn’t wearing it). Since I was unconscious, I don’t remember how long I was out for. I lost consciousness and woke up when the first responders got there. If the first responders responded from the station to the crash site, it’s a 20-30 min drive. It’s a 20 min drive to the hospital from the crash site. I lost consciousness at 5 times. They ended up intubating me and putting me on a ventilator. About a week later, I was weaned off of the sedation and had been med evac’d to the continental US. I have migraines on a daily basis and the migraines vary in severity. I have dizziness. I used to have 20/20 vision. When I woke up, I could only see 6 inches in front of my face. I now wear glasses with prescription, prisms due to convergence difficulty, and tint due to light sensitivity. I’m having difficulty reading and believe I might have acquired dyslexia. I used to be intelligent. I graduated at 16 from high school and went to college for pre med. After my wreck, I can’t even do simple math. I have difficulty remembering details and recent things that happened when before I had a photographic memory and could remember everything that I was told once. The MRI doesn’t show anything. I’ve been diagnosed with a mild TBI and neck injury at the Polytrauma at the VA. The new hospital that I’ve been sent to blames my neck injury and tries to say that I don’t have a TBI even though they firs saw me a year after the injury. I believe I have a moderate TBI because it’s been 2 yrs and my symptoms are worsening not getting better. The TBI clinic I’m going to isn’t helping me at all. When I bring in valid questions, I’m told that’s not a thing or you don’t have that without being examined. When I bring in scholarly articles about my valid questions, I’m told “Well I’m not the subject matter expert”. If the PA over my case is not the subject matter expert then why is she working at a physician in the TBI clinic? I’m trying to find a new clinic to go to. I live in San Antonio, TX

Daniella replied on

You seem pretty intelligent now based off your response. I hope you were able to find someone who could actually help you. My daughter was recently in a major car crash. After a while, it just seems like they write their patients off. Like nothing more can be done. Despite all the newest and latest research out there!

4 years PCS replied on

I feel you. (Highly intelligent; technical job. now 4 years tbi/concussion survivor with post-concussion syndrome (PCS). )

(My concussion was also classified as mild (because concussions are measured on the Glasgow Coma Scale. ok... so I can talk, open my eyes and move my hand on command; that does in no way mean that what we are going through is mild! )

Good that you are going to find a doctor or other medical professional (vestibular/vision/psychological, etc.) who gets it, even if you still have to keep going to that doctor for insurance purposes or whatever.

Keep up the good work; take care.

Anonymous replied on

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

Anonymous replied on

The test result should be NT (not testable) and the total score doesn't include eyes assessment

Rebekah A replied on

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.

Tia replied on

I’m so sorry about your husband I’m here because my child’s father is in icu with an enlarged heart and Covid I just learned that his GCS is also a 3 and I’m trying to keep faith. He’s on a ventilator with continuous dialysis. He had an hemorrhagic stroke as well and some brain bleed. My son is only 8 months and just to imagine that he’ll have to grow up without him hurts me to the core sucks. Keep us in your prayers if you can.

Shimma Almabruk replied on

I am sorry for your loss. My 13-year-old cousin is in a deep coma, GCS 3. She is also on a ventilator and has no response to light, pain or anything. Her brain has swollen due to homerrhage and had 2 cardiac arrests in the same day. Doctors said her condition is inoperable and that she may die any minute. We are very devastated and hope that she will wake up one day.

Wick replied on

I am a motorcycle rider as well. It makes me so sad to read this. So sorry for your loss! Stay strong!
Greetings from Austria, Wick

Marie replied on

So sorry that happened to you Rebecca. My son was hit by a car Dec.2011...severe TBI gsc 3...died twice...2 major seizures...was in a coma for 2 months and when he came out of it he was in a semi vegetative state..no eye contact..no talking...just rocking back and forth and rubbing his head and drooling. Drs said I need to put him in a care home where he can age safely and securely...24 yrs old. We could not accept that. As a family we did every possible thing to help him recover...14 hours a day...constant therapy. Music... touch stimulation...3 brothers holding him upright while I was on the floor moving his feet...I stayed in that province for almost a year. Every time he made a bit of progress the dr would say that was coincidence or that's all he will be able to do. I took over his complete care so he wouldn't be a burden on the nurses as I was scared they were going to xfer him to a care home. Almost one year later Corey walked out of that hospital with the exact same personality he had before ..has every memory from childhood ..makes us laugh every day. He will always have to live with us as the accident left him with short term memory loss and some cognitive impairments so he's on disability but his sight came back after about a year! We also weaned him off all the antipsychotic medications they had him on...terrible stuff!! Everyone out there..have hope and remember that Drs are not Gods!!

Shannon replied on

Thank you, I needed to hear this. My son was in an accident 3 1/2 weeks ago and still in a semi comatose state. I have faith, but it's hard to keep that up all the time. I scream, I cry, I have a breakdown every day on my way home from the hospital. So thank you, I really needed these words

Auska replied on

When I was comatose from an intentional drug overdose, my fiancé wanted to visit me badly but COVID prevented her from being able to and this devastated her. I was 6 on the scale given a poor prognosis but survived despite the doctors telling my fiancé to prepare for the worst because it was very unlikely I would recover.

Violet replied on

Thank you for sharing. I almost died 4 years ago. Slipped and fractured skull, I remember hearing the sound of ocean waves and knew I was dying. I lived alone and remained unconscious for 4 days. I had a tremendous amount of healing to do but the crazy part is, I didn’t tell anyone. I felt as just what you said - the doctors arent god and I was alive by a miracle. I didn’t want to hear fright and doom and took control of my healing. It was incredibly difficult to do but foods and herbs helped. Two years later I went in for mri’s I was still suffering a major concussion. But after I woke I had vomiting, dizziness, hearing problems, eyesight issues. My hair sheds out a lot today and I still have a soft spot where my skull fractured. I have a touch of dyslexia and have a hard time concentrating on reading but I knew I survived by a miracle and am back to myself but actually more improved. I believe something saved me so I could fulfill a purpose.

M replied on

What doctors have forgotten is God that is the supreme and able to do things against drs' expectations. brain is not just something physical but relates to soul and metaphysical entities which we may not see or understand. in a coma, our brain cells need time to reconstruct and revive; drs just give up and many of them do not believe in God.

Jen replied on

I hope you will believe me when I say it's best not to dwell on the "what ifs." You'll drive yourself crazy. I worked in an ICU and saw some people recover from horrible injuries, but most did not. If they weren't able to relieve the pressure on his brain, he would have herniated and the results would be the same. I have seen that there are worse things than death, from work and in my own life. My grandfather lived in a miserable state for 20 years after he survived being taken off the ventilator. He had a stroke after a brain aneurysm repair at 58 years old, so he lived with the damage from the stroke for all of that time. He was confined to a wheelchair, then bedridden for the last 3 years of his life. He only knew my grandmother, my mom, and his 3 other children. I felt like I lost my grandfather the day he went into the hospital for the aneurysm repair. My sister was flown by helicopter after being found unresponsive in her recliner at home. She had been there for 3 days. We still don't know what happened, I have suspicions about her odd neighbors since she had some trauma to her head on both sides, not something that would happen if she had fallen before sitting in her recliner. Her MRI was terrible. She had suffered a stroke or lack of oxygen to her brain, or both, they weren't sure, she was only 46 years old. Her brain was swelling, and she didn't respond to anything. I noticed she began to posture, which indicates severe brain damage. I knew that even if she survived and could breathe on her own, she would be in a vegetative state. We decided to take her off of the ventilator. It was 13 hours before she finally passed. I feel we made the right decision, but I wish I knew what had happened to her. I don't know why you weren't the one making the decisions since the spouse is the next of kin and I don't like it when physicians tell people that the person will pass away quickly, it's unrealistic to predict such things. More often than not, it takes longer if the person isn't absolutely brain dead. I'm so sorry for your loss, I hope you can find peace.

Bodisere Okoe replied on

Am so sorry about all you being through.. and I hope you find peace. Amen

Rajnish replied on

May god give you strength to overcome your loss. Please look after yourself and may your husband rest in peace

Anonymous replied on

I am so sorry for your loss and will pray for you. God please comfort this wife and help her get through this storm. Amen.

Pandey replied on

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.

Lisa replied on

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.

Kavelle replied on

My thoughts exactly Lisa. Hope Rebekah finds peace at this time.

Anonymous replied on

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??

Paul replied on

How did you score two, when there are three parts to the test, all with a minimum score of one?
I've just come out of hospital after suffering diabetic hypoglycemia and a seizure, which left me in a coma on my bedroom floor. Paramedics found and saved me. My GCS was 3 and I was very close to death.
I'm not belittling you in any way, just curious.

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