How to Score Glasgow Coma Scale

Today we are going to demonstrate how to score Glasgow Coma Scale (GCS). The GCS is a
neurological assessment for patients with suspected acute brain injuries from fall/accident, stroke, and
for monitoring patients admitted in the ICU. The Glasgow Coma Scale has 3 parameters with
corresponding scoring: Eye-Opening/Response (1-4points), Verbal Response (1-5 points), Motor
Response (1-6points).

We begin the assessment by assessing the first parameter which is the Eye Opening response.
We give 4 points if the patient opens his eyes spontaneously or maintains eye contact. Three points if
the patient opens his eyes after calling his name twice. Two points if the patient opens eyes after
applying peripheral pressure. One point if there is no eye-opening response at all.

For the second parameter, Verbal Response, we assess the patient by asking basic questions
about the date, time, place, and name. We give 5 points if the patient is alert and oriented to time,
place, date, and identity. Four points if the patient has some level of confusion. Three points if the
patient uses inappropriate words (e.g when the patient was asked for his name, he answers “airplane”).
Two points if the patient makes incomprehensible sounds such as moaning, groaning, grunting, crying,
etc. One point if there is no verbal response at all.

Then, for the Motor response, we’re assessing if the patient can obey verbal commands such as
squeezing your hand or blinking his/her eyes. If there’s no response from the verbal command, assess
how the patient responds to applied peripheral pain/pressure. We give 6 points if the patient obeys
verbal commands. Five points if the patient localizes the pain. Four points if the patient withdraws from
the pain. Three points if the patient demonstrated an abnormal flexion (decorticate position) after
applying peripheral pain. Two points if the patient has an abnormal extension (decerebrate position).
And one point if the patient has no response at all.

The assessment for GCS should be performed accurately because the data gathered will be used
to gauge the severity of the brain injury. The scores from the different parameters will be combined to
get the total GCS score. 15 points is the highest possible score which indicates that the patient is fully
awake and alert and the lowest possible score is 3 points. 13-14 points indicate minor brain injury. 9-12
points indicate moderate brain injury. GCS score of 8 indicates severe brain injury, and GCS score of
equal to or less than 7 points indicates that the patient is in a state of coma.