Glasgow Coma Scale (GCS)

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

This gives a reliable, objective way of recording the conscious state of a person.[1] It can be used by medical and nursing staff for initial and continuing assessment. It has value in predicting ultimate outcome. Three types of response are independently assessed and are recorded on an appropriate chart (and the overall score is made by summing the scores).

The calculator has been adapted to estimate the Glasgow verbal score from the Glasgow eye and motor scores in intubated patients.[2]

There is a Paediatric Glasgow Coma Scale applicable to infants too young to speak - and the equivalent infant responses are given in the various sections below.[3]

1. Best motor response (M) - 6 grades

Apply varied painful stimulus: trapezius squeeze, earlobe pinch, supraorbital pressure, sternal rub, nail-bed pressure, etc:
  1. No response to pain.
  2. Extensor posturing to pain: the stimulus causes limb extension (abduction, internal rotation of shoulder, pronation of forearm, wrist extension) - decerebrate posture.
  3. Abnormal flexor response to pain: stimulus causes abnormal flexion of limbs (adduction of arm, internal rotation of shoulder, pronation of forearm, wrist flexion - decorticate posture.
  4. Withdraws to pain: pulls limb away from painful stimulus.
    Infant: withdraws from pain.
  5. Localising response to pain: purposeful movements towards changing painful stimuli is a 'localising' response.
    Infant: withdraws from touch.
  6. Obeying command: the patient does simple things you ask (beware of accepting a grasp reflex in this category).
    Infant: moves spontaneously or purposefully.

2. Best verbal response (V) - 5 grades

Record best level of speech. If the patient is intubated, a 'derived verbal score' is calculated via a linear regression prediction:
  1. No verbal response.
  2. Incomprehensible speech: moaning but no words.
    Infant: inconsolable, agitated.
  3. Inappropriate speech: random or exclamatory articulated speech but no conversational exchange.
    Infant: inconsistently inconsolable, moaning.
  4. Confused conversation: the patient responds to questions in a conversational manner but some disorientation and confusion.
    Infant: cries but consolable, inappropriate interactions.
  5. Orientated: the patient knows who he/she is, where he/she is and why, the year, season, and month.
    Infant: smiles, orientated to sounds, follows objects, interacts.

3. Best eye response (E) - 4 grades

  1. No eye opening.
  2. Opening to response to pain to limbs as above.
  3. Eye opening in response any speech (or shout, not necessarily request to open eyes).
  4. Spontaneous eye opening.
Glasgow Coma Scale Score (max 15):(Derived Verbal score: )
Interpretation of Symptoms: (Severe: 8 or less; Moderate: 9-12; Mild: 13 or more)

The calculator above has been adapted from The Lancet, Vol 2 (7872) Teasdale G, Jennett B; Assessment of coma and impaired consciousness. A practical scale. pp81-4. ©1974 with permission from Elsevier. The calculator also provides calculated scores for intubated patients using linear regression as described in Meredith W, Rutledge R, Fakhry SM, et al; The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma. 1998 May; 44(5):839-44.

Some centres score GCS out of 14, not 15, omitting 'withdrawal to pain'. As well as the total figure, the GCS can be expressed as subscores: GCS=15; M6, V5, E4 (motor, verbal and eye-opening responses)

Abbreviated coma scale (AVPU)

This is sometimes used in the initial assessment ('primary survey') of the critically ill.

  • A = alert
  • V = responds to vocal stimuli
  • P = responds to pain
  • U = unresponsive

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