Glasgow Coma Scale (GCS)

The Glasgow coma scale measures 3 different types of response. These are:

• best motor response - 6 grades
• best verbal response - 5 grades
• eye opening - 4 grades

An overall score is made by summing the score in the 3 assessed areas. The lowest possible score is 3. The maximum is 15.

Generally in managing patients, a score of 8 is felt to be the threshold - less than 8 implies a significant problem.

Notes (1):

• monitoring and exchange of information about individual patients should be based on the three separate responses on the Glasgow Coma Scale (for example, a patient scoring 13 based on scores of 4 on eye-opening, 4 on verbal response and 5 on motor response should be communicated as E4, V4, M5)
• if a total score is recorded or communicated, it should be based on a sum of 15, and to avoid confusion this denominator should be specified (for example, 13/15)
• individual components of the GCS should be described in all communications and every note and should always accompany the total score
• the paediatric version of the Glasgow Coma Scale should include a 'grimace' alternative to the verbal score to facilitate scoring in pre-verbal children

Reference:

1. NICE (September 2007). Head injury guideline