Glasgow Coma Scale (GCS)

The GCS is used to assess the level of consciousness after head injury and is now applicable
to all acute medical and trauma patients. 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).
The GCS, which was developed, validated, and used widely to assess the level of
consciousness and prognosis of patients with acute traumatic brain injuries (Rowley and
Fielding, 1991) and non-traumatic causes of coma (Mullie et al. , 1988), is insufficient for the
assessment of vegetative state and minimally conscious state because of its crude
measurement of awareness and its omission of relevant neurological functions (Howard and
Hirsch, 1999).


Eye Response

Does not open eyes 1 point
Opens eyes in response to painful stimuli 2 points
Opens eyes in response to voice 3 points
Opens eyes spontaneously 4 points

Verbal Response

Makes no sounds 1 point
Incomprehensible sounds 2 points
Utters inappropriate words 3 points
Confused, disoriented 4 points
Oriented, converses normally 5 points

Motor Response

Makes no movements 1 point
Extension to painful stimuli (decerebrate response) 2 points
Abnormal flexion to painful stimuli (decorticate response) 3 points
Flexion / Withdrawal to painful stimuli 4 points
Localizes painful stimuli 5 points
Obeys commands 6 points