Glasgow coma scale

The Glasgow coma scale (GCS) was developed in 1974 1 to describe the level of consciousness specifically in patients with head injury although it is now used widely as a shorthand for all manner of presentations and has generally been validated, although concerns about its use in certain scenarios 2-3

It measures the best eye, verbal and motor responses. Each is graded from worst (=1) to best (4, 5 and 6 respectively) and the grades added together, such that the lowest possible score is 3 and the highest is 15.

Graded 1-4:

  1. no eye opening
  2. eye opening in response to pain
    • patient responds to pressure on the patient’s fingernail bed 
    • if this does not elicit a response (or hands are unavailable) supraorbital and sternal pressure or rub may be used
  3. eye opening to speech
    • not to be confused with the awakening of a sleeping person (such patients receive a score of 4, not 3)
  4. eyes opening spontaneously

Graded 1-5:

  1. no verbal response
  2. incomprehensible sounds
    • groaning or moaning but no words
  3. inappropriate words
    • random or exclamatory articulated speech, but no conversational exchange
  4. confused
    • responds to questions coherently but there is some disorientation 
  5. oriented
    • responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.

Graded 1-6

  1. no motor response
  2. extension to pain
    • extensor posturing: abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response
  3. abnormal flexion to pain
    • flexor posturing: adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response
  4. flexion/withdrawal to pain
    • flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied; pulls part of body away when nailbed pinched
  5. localises to pain
    • purposeful movements towards painful stimuli
  6. obeys motor commands
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Article Information

rID: 19412
Synonyms or Alternate Spellings:
  • Glasgow coma scale (GCS)
  • GCS

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