Glasgow Coma Scale (GCS)

Subscales

E — Eye Opening	Score
Spontaneous	4
To voice / verbal command	3
To pain / pressure	2
None	1

V — Verbal Response	Score
Orientated	5
Confused / disoriented	4
Inappropriate words	3
Incomprehensible sounds	2
None	1

M — Motor Response	Score
Obeys commands	6
Localises pain	5
Normal flexion (withdrawal)	4
Abnormal flexion (decorticate)	3
Extension (decerebrate)	2
None	1

Total Score Interpretation

GCS Total	Severity
13–15	Mild
9–12	Moderate
3–8	Severe (GCS ≤ 8 = indication for intubation)

EVM Notation

Results should always be reported in EVM format (e.g. E3V4M5 = GCS 12) to allow clinicians to identify which component is impaired. Reporting only the total sum obscures important clinical information — a patient with E1V1M6 and one with E3V3M2 both score 8 but have very different presentations.

Assessment Notes

• Record the best response from each component — do not average or take worst.
• For intubated patients, verbal response is scored as VT (intubated) or VA (tracheostomy, aphasic), and should not be imputed as 1.
• Motor response is the most prognostically powerful component; it should never be omitted.
• Serial GCS measurements over time are more informative than any single value — a falling GCS indicates clinical deterioration requiring immediate re-assessment.

Literature

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–84.