Glasgow Coma Scale

• 4 = spontaneous
• 3 = to voice
• 2 = to pain
• 1 = none

• 5 = normal conversation
• 4 = disoriented conversation
• 3 = words, but not coherent
• 2 = no words, only sounds
• 1 = none

• 6 = normal
• 5 = localized to pain
• 4 = withdraws to pain
• 3 = decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest)
• 2 = decerebrate (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards)
• 1 = none

Clinicians use this scale to rate the best eye opening response, the best verbal response, and the best motor response an individual makes. The final GCS score or grade is the sum of these numbers. Using the Glasgow Coma Scale Every brain injury is different, but generally, brain injury is classified as:

• Severe: GCS 3-8 (You cannot score lower than a 3.)
• Moderate: GCS 9-12
• Mild: GCS 13-15

Mild brain injuries can result in temporary or permanent neurological symptoms and a neuro-imaging tests such as CT scan or MRI may or may not show evidence of any damage. Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills, and/or emotional/behavioral functioning. Limitations of the Glasgow Coma Scale Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the GCS. Children and the Glasgow Coma Scale The GCS is usually not used with younger children, especially those too young to have reliable language skills. The Pediatric Glasgow Coma Scale, or PGCS, a modification of the scale used on adults, is used instead. The PGCS still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together. Here is the slightly altered grading scale for the PGCS:

• 4 = spontaneous
• 3 = to voice
• 2 = to pain
• 1 = none

• 5 = smiles, oriented to sounds, follows objects, interacts
• 4 = cries but consolable, inappropriate interactions
• 3 = inconsistently inconsolable, moaning
• 2 = inconsolable, agitated
• 1 = none

• 6 = moves spontaneously or purposefully
• 5 = withdraws from touch
• 4 = withdraws to pain
• 3 = decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest)
• 2 = decerebrate (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards)
• 1 = none

Pediatric brain injuries are classified by severity using the same scoring levels as adults, i.e. 3-8 reflecting the most severe, 9-12 being a moderate injury and 13-15 indicating a mild TBI. As in adults, moderate and severe injuries often result in significant long-term impairments. References Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. PMID 4136544.