Glasgow Coma Scale (GCS)


Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form “GCS 9 = E2 V4 M3 at 07:35”.

Generally, brain injury is classified as:

  • Severe, GCS < 8–9
  • Moderate, GCS 8 or 9–12 (controversial)6
  • Minor, GCS ≥ 13.

Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. “E1c”, where “c” = closed, or “V1t” where t = tube). Often the 1 is left out, so the scale reads Ec or Vt. A composite might be “GCS 5tc”. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for “abnormal flexion”.

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently, the Pediatric Glasgow Coma Scale was developed for assessing younger children.



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