Glasgow Coma Scale

Fundamental Review 17-3

Glasgow Coma Scale

The Glasgow Coma Scale (GCS) evaluates three key categories of behavior that most closely reflect activity in the higher centers of the brain: eye opening, verbal response, and motor response. Within each category, each level of response is given a numerical value. The maximal score is 15, indicating a fully awake, alert, and oriented patient; the lowest score is 3, indicating deep coma (Hickey & Strayer, 2020). The GCS is used in conjunction with other neurologic assessments, including pupillary reaction and vital sign measurement, to evaluate a patient's status.

Component	Score	Response
Eye opening	4	Opens eyes spontaneously when someone approaches
	3	Opens eyes in response to speech (normal tone or shouting)
	2	Opens eyes only to painful stimuli (apply pressure with a pen to the lateral outer aspect of the second or third finger, up to 10 seconds, then release)
	1	No response to painful stimuli
Best motor response	6	Accurately responds to instructions; obeys a simple command, such as “Lift your left hand off the bed”
	5	Localizes (moves hand to point of stimulation) to painful stimuli and attempts to remove source
	4	Flexion reflex action, but unable to locate the source of pain; purposeless movement in response to pain
	3	Flexes elbows and wrists while extending lower legs to pain; decorticate posturing
	2	Extends upper and lower extremities to pain; decerebrate posturing
	1	No motor response to pain on any limb
Best verbal response	5	Converses; oriented to time, place, and person
	4	Converses; disoriented to time, place, or person; any one or all indicators
	3	Converses only in words or phrases that make little sense in the context of the questions
	2	Responds with incomprehensible sounds; no understandable words and/or moaning, groaning, or crying in response to painful stimuli
	1	No response

Source: Adapted from Hickey, J. V., & Strayer, A. L. (Eds.). (2020). The clinical practice of neurological and neurosurgical nursing (8th ed.). Wolters Kluwer; Okamura, K. (2014). Glasgow Coma Scale flow chart: A beginner's guide. British Journal of Nursing, 23(20), 1068-1073; and Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2(7872), 81-84.

section name header

Fundamental Review 17-3