Glasgow Coma Scale


Eye Opening
4 - spontaneous.
3 - to voice.
2 - to pain.
1 - none.

Best Verbal
5 - oriented.
4 - confused.
3 - inappropriate words.
2 - sounds (incomprehensible).
1 - none.

Best Motor
6 - obeys commands.
5 - localises pain.
4 - withdraws (pain).
3 - flexion (pain).
2 - extension (pain).
1 - none

For children

Replace verbal score with:
5 - appropriate words or social smile, fix and follow
4 - cries, consolably
3 - persistently irritible
2 - restless, agitated
1 - none.

Notes
1974 - Teasdale and Jennet.
Coma or severe brain injury suggested by GCS<8
Must use sufficient pain.
- best at supraorbital ridge - localisation if pt brings arm above chin.
- flexion or contraction measured by pressing a pen firmly on nail (all limbs).
Record the best response
- eg if one limb flexes, another extends, record the flexion.
- arms are more reliable than legs.
Useful as a trend indicator - extremely sensitive for detecting deterioration in conscious state.
- And thus for preventing secondary brain injury.
On the observation sheet, use one X if both sides affected in same way, or both R and L if sides responding differently.
Some evidence that best motor response is as sensitive as entire GCS.
- best motor response is the most reliable predictor of outcome.