Glasgow Coma Scale (GCS)

This is made up of three categories of responsiveness (EVM):

  • Eye-opening

  • Verbal responses

  • Motor responses (movement)

GCS is scored out of 15, with a lowest possible score of 3 (intubated and sedated or deceased).

Eye-opening – scored out of 4.

  • 1. No eye opening

  • 2. Eyes open to painful stimuli

  • 3. Eyes open to voice

  • 4. Eyes are open spontaneously

Verbal response – scored out of 5.

  • 1. No speech

  • 2. Incoherent speech

  • 3. Inappropriate speech

  • 4. Confused

  • 5. Oriented

Motor response – scored out of 6.

  • 1. No movement

  • 2. Extending movement (decerebrate)

  • 3. Flexing movement (decorticate)

  • 4. Withdraws from painful stimulus (ie will move entire hand or limb away from a hand squeeze)

  • 5. Localises to painful stimulus (ie will push person away from squeezing the hand)

  • 6. Obeys commands

Important GCS Numbers for context of scenarios:

3/15 – intubated and sedated, or deceased.

8/15 – below this level they are deemed to be not safe to maintain their own airway and will need assessment by anaesthetists to consider intubation and breathing support. After head injury it is recommended that patients with GCS of lower than 8 are considered to be immediately taken to a hospital with a neuroscience/neurosurgical department on site – usually they will be intubated at the scene by paramedics/doctors and bypass scanning at smaller ED departments.

12/15 – CT HEAD within 1 HOUR

14/15 – CT HEAD within 8 HOURS, although this is normal GCS for someone with dementia and similar conditions (permanently scoring lower for confused speech)

15/15 – normal healthy adult; if lower than this 2 hours after HI will require a CT HEAD within 1 HOUR