Neurocritical Care
Neuro Assessments & Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS) description, component scoring, and application in trauma and surgical critical care.
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Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a tool used to assess a person's level of consciousness after brain injury. It is based on three...Section
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a tool used to assess a person's level of consciousness after brain injury. It is based on three...The Glasgow Coma Scale (GCS) is a tool used to assess a person's level of consciousness after brain injury. It is based on three parameters:
- Eye response (E) — 1 to 4
- Verbal response (V) — 1 to 5
- Motor response (M) — 1 to 6
- Total GCS score:* 3 to 15
- 3 = worst
- 15 = best / fully alert
GCS Components
Score • Response • 4Section
GCS Components
Score • Response • 4Eye Response (E)
| Score | Response |
|---|---|
| 4 | Opens eyes spontaneously |
| 3 | Opens eyes to voice |
| 2 | Opens eyes to pain |
| 1 | No eye opening |
Verbal Response (V)
| Score | Response |
|---|---|
| 5 | Oriented |
| 4 | Confused |
| 3 | Inappropriate words |
| 2 | Incomprehensible sounds |
| 1 | No verbal response |
Intubated patients: Verbal score cannot be fully assessed. Document as GCS-V1T (intubated). Some centers use GCS-T to indicate tracheostomy.
Motor Response (M)
| Score | Response |
|---|---|
| 6 | Obeys commands |
| 5 | Localizes pain |
| 4 | Withdrawal from pain |
| 3 | Abnormal flexion (decorticate) |
| 2 | Abnormal extension (decerebrate) |
| 1 | No motor response |
GCS Severity Classification
GCS Score • Severity • 13–15Section
GCS Severity Classification
GCS Score • Severity • 13–15| GCS Score | Severity |
|---|---|
| 13–15 | Mild |
| 9–12 | Moderate |
| ≤8 | Severe (coma; unable to follow commands) |
- GCS ≤ 8:* Consider need for airway protection. Consult neurosurgery. Evaluate for emergent CT head.
Clinical Pearls
Motor response is the most prognostically significant component • Pupil exam, lateralizing signs, and GCS together guide...Section
Clinical Pearls
Motor response is the most prognostically significant component • Pupil exam, lateralizing signs, and GCS together guide...- Motor response is the most prognostically significant component
- Pupil exam, lateralizing signs, and GCS together guide neurosurgical urgency
- Serial GCS measurements document trajectory — trending down is more concerning than a single low value
- In sedated or pharmacologically paralyzed patients, GCS cannot be reliably assessed — document medications affecting assessment