Glascow Coma Score
The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).
Best eye response (E) There are 4 grades starting with the most severe:
Best eye response (E) There are 4 grades starting with the most severe:
- No eye opening
- Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
- Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
- Eyes opening spontaneously
- No verbal response
- Incomprehensible sounds. (Moaning but no words.)
- Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
- Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
- Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)
- No motor response
- Extension to pain (abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)
- Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
- 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)
- Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
- Obeys commands. (The patient does simple things as asked.)
- Severe, with GCS ≤ 8
- Moderate, GCS 9 - 12
- Minor, GCS ≥ 13.