What Is the Glasgow Coma Scale?

BrainLine
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 (162)

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.

?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.

God bless you

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?

I am the survivor of a glasgow coma score of 3. I am able to walk, talk,and function. Praise God

I was a 3 for four days. Everything in life happens for a reason and it's our job to remove judgment in waiting for the answer. I am in the process of writing a book about my experiences as motivation to even the uninjured, but especially for head injury victims and their families in learning how to deal. My experience is more than I can share right now. I have a TBI so organizing and getting it complete is a bit of a challenge, but it will be done. Me talking about my experiences have changed lives in drastic ways for the good. I have been witness to friends with injuries that were less severe than mine...die. This had left me with survivors guilt for many years so in an attempt to not waste my life and with the use of the internet and some pretty good discernment I was able to understand myself. This later turned into me seeing it in everything from people to animals to nature itself. There is a common truth and any separation from that is only a lack....A lack of the truth of nature, love. Everything is love. The trees don't struggle to reach the sky, nor does a river 'try' to flow downstream. 

My son age 22 went from a 3 to a 12 with his brain injury. He couldn't swallow or talk. I had to fight with the hospital to get him fed. He lost 7 stone died at 5 stone. Now I'm going to a inquest in 7 weeks and I'm so scared

My father was in a motorcycle accident 3 days ago and in a coma since. He is 60 years old. He was scored at a 3 upon getting to the hospital and yesterday an 8. He has diffuse axional injury. I am praying all day every day. He has so many broken bones but of course the brain injury is the concern. He was on the highway when the oil leaked and he lost control of the bike crashing into a jersey barrier After researching the brain injury i haven't been able to stop crying. But since coming here and reading so many positive stories I am building my hope up and putting faith in my dads recovery. I don't care what extent of help he needs going forward I will give everything I can for him. I just want to see him wake up and be given the chance at life again. God bless all of you and thank you for sharing your stories. If anyone would like to talk and discuss anything at all or just to support one another please email me. Tasha02421@gmail.com

My mom is in SICU. Had ICH and source of bleeding is unknown. angiogram CT nor MRI showed any significant finding of source . Currently in GCS score of M3 Vt E2 and doctors stated bad prognosis. Tomorrow they are planing tracheostomy. She also developed fever too.

My brother had a acute basal ganglia and is currently in GCS4 stage. He collapsed while normal office working. He has no medical history for his 55 years of life and has a very healthy body. Want to know his chances of recovery. Doctors says only miracle can help. But we are in a small place in India and don't know if to trust the doctors here completely for it. Please suggest.

My son was GCS 3 after a sudden collapse in September last year. He remained at this GCS 3 days and on the second day he did not react to a lumbar puncture without sedation nor anesthetic. We were told to very much expect the worst outcome. But he is still here, fit and strong. Some minor issues (comparatively, but we can deal with anything now) as suffers hypoxic brain injury, quick to anger and low moods, but have faith if in this situation. There is still hope if GCS 3. 

If a patient's GCS is resulting in a 12... would this be grounds for informing the Dr. or is it more likely to be a 'monitor patient closely' level?

My helmetless motorcycle accident was three weeks ago.  I was GCS3 with BFPD, and my family was told that I wasn't likely to regain consciousness.  Here I am, a bit worse for the wear, but happy to be alive.  To read this material helps me realize just how lucky I am to be alive, and it always helps knowing you're not alone in your struggles.

Struggling much now with the TBI symptoms... overwhelmed so easily with information, and for an IT professional, this has a huge impact.  My biggest struggle now is the narrow band of emotional stability.  I am so easily drawn from my mid-ground to a point of anger or anguish.

Whether you are the injured one or a friend/family member, be patient and remember to back away when you need to.  I don't mean to become angry, and I don't mean to cry, but it seems to be somewhat beyond my control when these things happen now.

Be strong, but also be patient with yourself and with others.

I am currently sitting beside my daughters hospital bed, for yesterday she came off a quad bike going slowly around a corner. Initially she had a gcs of 3 for 15mins, which came up to 8 for a further 15 then 13 after that.  She has a torn ligament c1&2 and bruising to her frontal lobe, but she is going well.  God must have sent an army of angels to protect her.  So to all the mums and dads out there sitting beside beds there is hope!  Thank you to the authors of this article, you helped me better grasp what happened and how to explain more succinctly to health workers.

Well done you. Look after yourself

Thank you for sharing!!!

I am an RN with experience on both sides of the bed rail. in 2010 I fell off a cliff and fell onto hard bare steel. I had a broken pelvis, an open fracture of my arm (bone sticking out), and a LeForte fracture of my face, broken through the eye sockets, down through the cheek bones and across the bone of my upper mandible. And my skull was so badly fractured my brain was bleeding and had air inside it. I was flown away in the helicopter to the ICU where I used to work and put on a ventilator. of the accident and the following 3 weeks I have no memory, which is probably a good thing. I read that my Glasgow coma scale was 9. For a long time, the first year after I got out of the hospital I was pretty messed up. But here is the thing that can happen.  Every brain cell is attached to other cells in the brain by a long white tail called the axon. And somehow, down in the dark inside the brain, out of the 100 billion cells they can find each other again. This is proof of god's existence. Well, after that I needed four plastic surgeries on my face, three on my arm, and one to restore the sight in one eye. Hey- good as new.

When my son was born he was 16 weeks premature. I happened to know the exact day I got pregnant because his father came home for 24 hrs before being deployed again. He died 2 weeks after I found out I was pregnant. The letter I wrote him telling him the good news never made it in time for him to even know that we were expecting. Our son was born exactly 24 weeks gestation. He was 1lb 7oz and only 12 1/4 inches long. He was diagnosed with a stage 4 inner ventricular hemorrhage to the entire left hemisphere of his brain. Basically the entire left side of his brain was bleeding and coveted in blood clots. The Dr said that he was too weak and little for surgery and that since he was already on life support that the likely ability of our son even making it through was less than 10%. The Dr said that I should stop life support and let him go. He said that even if my son made it that he'd never walk, talk, play, understand, or in any way be a normal child. That night I had him christened and I prayed like I'd never prayed before. My son is now 11 yrs old, almost 5 feet tall, 80+lbs, and he walks, talks, and plays just like a normal child. He is autistic and has a few medical issues but to look at him you'd never know his struggle. He's happy, healthy, and he saved my life during a time that all I wanted to do was give up. So, Dr's, science, medicine...they aren't always right. It's opinions based on the best guess of the medical facts that they have on hand at the given time. Dr's are people. Not God's, not magicians, they cannot alter the outcome of life. All they can do is try. Go with your heart. I'm not sure if it was really God that saved my sons life or if it was luck or destiny or fate but it doesn't hurt to believe and it doesn't hurt to pray. I hope that our story helps someone who is reading it. I hope it gives you comfort and the hope to withstand another day. Every second of life is precious but promised to no one. Live in this moment. Love as hard as you can. Stay strong no matter the battle you are facing or the outcome that will inevitability follow. Only the hardest battles are given to the strongest warrior's......

My mother went into cardiac arrest a few days ago during an operation at the hospital. After a few minutes of CPR and 6 epi shots, they were able to bring her back. They cooled her body down to 91 degrees to help preserve brain tissue and then warmed her up.  This process took 48 hours.  As of 5:30 pm today, her body temperature is normal and her vitals look good.  That being said, she is in a comatose state at the moment.  She is a peritoneal dialysis​ patient, and the doctors think that some of the anesthesia​ still exists in her peritoneal fluid, so they are exchanging her fluid tonight to see if this helps.  As far as I know, the doctors have not performed a Glasgow Coma test yet.  I read the scale and I would rate her about a 7-8, but I may be completely wrong.  Those of you who were in comas have given me some hope, and I felt that I needed to express this.  Thank you dearly, and if you could please find it in your heart, please pray for my mother Belinda. 

To the person who commented on 11/28/15, and probably others, the tests can be strong indicators, but the numbers aren't the final word as with any diagnosis. A rotation or visits to the unit will let you know if it's for you or not. I've had quite a few minor TBIs and a moderate in the mid range from a car accident in 1990 that I shouldn't have survived. What initially helped me the most were the nurses in the ICU. Their compassion and caring helped me heal more than anything else. I helped them because they rarely had a patient not in a coma. They were so excited to be able to interact with a patient and I will always be grateful for the care I received. I've been a tax-paying, highly functioning member of society since then. It's not always easy and some adverse effects will probably never go away, especially memory and emotional problems, but that's manageable given how bad it could and should have been. I also have a friend that received a far more serious TBI than I did and she's also beat the odds that she was given. My sister was a neuro nurse and said it was incredibly difficult because so many never recover. Just like any other unit, some can do it and some can't.

My 14 yr old daughter entered the hospital via air transport with a glasgow scale 3 . with orbital injury and right ear injury . she suffered diffuse axonal injury ( sheering) we were in the hospital 2 months when she walked out the door . within 3 months of that she was in school making straight As! The brain is a truly unique thing. And God is always good !

Thank you all for sharing your stories. I am a graduate nurse preparing for my board exam and I have really wondered if this profession is the right place for me. I have also wondered about the Neuro nursing. I've heard stories of it being full of 'no hope' situations. Your stories breath life into me and make me feel there is a hope after all and that if I do my part, a miracle is possible. Thanks!

My friend was in a motorcycle accident with crushed skull.  He was in a coma for 4 months and the Dr's told his parents he had no brain activity and was a donor.. They never took him off life support.. Then he started to come around,  and after a long rehab he is back to work as a firefighter doing great... You never know..  Now we are going through this with my brother in law.. He was a 3 when he went in.. After 5 days he started to come around and is now off off of life support and trying to speak.. Now he is a 5  we are hoping for a miracle and he gets back to normal..

I am undergoing a bridging program which will enable me sit the Canadian Nursing exam. I must say that i am well informed by the article i read here an they are very simplified. Keep up the good work.

I was hospitalised in critical care for a medication overdose by a public hospital early 2013 and the CCU said my GCS dropped but didn't say to what, then went up to 13 then down to 10 and nothing after that to indicate what it was on discharge. How do I find out what it is now?

I went into a public hospital and was administered an incorrect medication about 15 times the manufacturers recommended dose for a first time patient and was put on Life Support in an Induced Coma for 2 days with a GCS of 10. Can someone tell me if this rating is permanent or does it get better over time please?

My partner was hit by a car and he had a compound fracture on his femur . The next morning he was in a COMA and we are on day nine and he rated a 3 on this scale. His brain is rittled with fat emboli . What long term hope to we have of recovery or quality of life. specialists said they have NEVER seen this kind of fat emboli in brain. 

Can we use this scale for this typed of trauma or does it matter 

thank you  

Hello... My name is Lisa I am the survivor of 28 days on the vent. My score was a 4. I do have a brain injury but my recovery was much easier than expected. Miracles really do happen.

to the person who posted their question on August 6th about their dad on the ventilator, I have the same question about my mom as you have about your dad. Could you email me at jjojmac@gmail.com if possible? I would like to share stories and see if we can find out more about this together

My father had a RTA and taken to hospital with GCS of 10 & I.C hematoma, sooner it dropped down drastically to 3. We shifted him to the best hospital in city. Doctors put him on ventilator for a day and half, then we were told that he had stopped breathing himself and is respirating completely with the help of ventilator. They performed numerous tests on him and after 2 days they declared him "brain stem dead". Was there any chance of recovery if he would have kept on ventilator for some more time? We consulted 5-6 doctors, best of best, but nobody gave us any hope and we were told that the damage to the brain was permanent and irrireversable and there is no point of keeping him on ventilatory support. I just wanted to know whether or not there was any chances of survival or recovery? What is the difference between brain dead and coma?

My uncle was in a motorcycle accident a month and a 1/2 ago. He went into a rehab facility after a month with barely anything functioning except his right eye and right side. When going in, they scored him a 3. After a wk, they scores him a 10. He has such a long way to go but after reading some of your comments i have more hope. My heart aches seeing him fight for his life but if others could make it, i know he xan!

I'm a tbi coma survivor. I was in a coma for a week. I lost my memory, voice and the ability to function when I woke. I started over again from learning how to sit. Doctors can never guess where I came from today. I'm now a college graduate and yoga instructor. I still have my daily struggles. I have dry eyes after the accident and suffered an undiagnosed soft tissue injury that I am still seeking treatment for, but i have come a long ways. So never give up and never quit! Doctors never told me I'd be where I'm at, but I am.

My daughter Jeniece was in a vehicular accident I Barbados. She was at 3 on the GCS when admitted to the hospital. She climbed from 3-15 in 3 months.

2 yrs later she's doing so much better with her mobility and cognitive ability.

Denise

I was rated at 3 after a car accident on my way to start and early shift in an emergency ward where I worked. I had major breaks through my head face neck and back lost total hearing in my left ear and partial in my right I also fractured my left temporal and the left orbit which caused a tennis ball sized haematoma which they feared had done irreversible damage. They expected me to be in a vegetative state if I ever regained consciousness and I would never walk again. Well after a lot of blood sweat tears physio on my left Bell's palsy. People are shocked when they hear what I went through because even though I had major injuries (eye haematoma subsided in hospital) it was all internal so it was very hard for people to understand I had suffered a TBI because they automatically think you would be a "vegetable" even though it ended my medical career, I went on to study forensic psychology criminology behavioural studies/criminal behaviour and loving it. So yes going from nearly dead to now walking talking chewing!! And a second chance at life, the brain really is an amazing cell.

This is really educative, it is an eye opener to me as a psychiatric nurse in making

Thank you for this information. Doesn't it just wind you right up when people criticize articles when clearly they have no idea?... Person below, the lowest score you can have is 3, so evidently your GCS did not "bounce from 1-3". 

well according to what is stated...(Above) I was in A GCS of lvl0-3 for a week...lvl0 for if i remember correctly 24 hrs After that I bounced from gcs1-3.

should'nt I have A Death Cert?????

Pages