Chart — Neurology
Glasgow Coma Scale Scoring Chart
The Glasgow Coma Scale is a standardized tool for assessing level of consciousness across three domains: Eye opening, Verbal response, and Motor response. It is used in trauma, stroke, post-op, and ICU settings to establish baseline neurological status and track changes over time.
Educational use only. GCS must be applied by a trained clinician in context. Factors such as intubation, sedation, pain, and language barriers can affect scores. Always document modifiers (e.g., “unable to assess verbal — intubated”). This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Eye Opening (E)
Max 4 points| Score | Response | Assessment Cue |
|---|---|---|
| 4 | Spontaneous | Eyes open without stimulation |
| 3 | To sound / voice | Eyes open in response to verbal command |
| 2 | To pressure / pain | Eyes open in response to sternal rub or nail-bed pressure |
| 1 | No eye opening | No response to any stimulus |
| NT | Not testable | Eyes swollen shut, orbital trauma |
Verbal Response (V)
Max 5 points| Score | Response | What It Looks Like |
|---|---|---|
| 5 | Oriented | Correctly states name, place, date (person, place, time) |
| 4 | Confused | Converses but disoriented; incorrect information |
| 3 | Words (inappropriate) | Single words; no sustained sentences; may curse or shout |
| 2 | Sounds (incomprehensible) | Groaning, moaning — no recognizable words |
| 1 | No verbal response | No sound even with stimulation |
| NT | Not testable | Intubated — document as “V = 1T” or “V = NT” |
Motor Response (M)
Max 6 points| Score | Response | What It Looks Like |
|---|---|---|
| 6 | Obeys commands | Follows two-step motor commands (e.g., “squeeze my hand”) |
| 5 | Localizing pain | Moves hand toward stimulus to push it away (purposeful) |
| 4 | Withdrawal from pain | Pulls away from pain stimulus (non-purposeful) |
| 3 | Abnormal flexion (Decorticate) | Wrists flexed inward, arms to chest — cortical dysfunction |
| 2 | Abnormal extension (Decerebrate) | Arms and legs extended, wrists rotated outward — brainstem dysfunction |
| 1 | No motor response | No movement even with deep pain stimulus |
The motor subscore is the most predictive of neurological outcome. Always assess the best response from any limb.
Total GCS Score Interpretation
| Total Score | Severity | Clinical Significance |
|---|---|---|
| 15 | Normal | Fully conscious and oriented |
| 13 – 14 | Mild impairment | May indicate mild TBI or early encephalopathy; monitor closely |
| 9 – 12 | Moderate impairment | Significant neurological dysfunction; high observation needed |
| 3 – 8 | Severe impairment / Coma | GCS ≤ 8 — airway protection likely compromised; consider intubation |
| 3 | Minimum possible | Deep coma or death — no response in any domain |
Report the score as a total AND by subscale (e.g., E3V4M5 = GCS 12). Changes of ≥ 2 points warrant immediate provider notification.
Nursing Considerations
- Establish baseline early — document initial GCS on admission and after any change in status
- Always report the best response per domain from any limb; do not average
- GCS ≤ 8 — notify provider immediately; prepare for possible airway intervention
- Trending — a declining score is more significant than a single low reading; report any drop of ≥ 2 points
- Confounders — document sedation level, intubation, aphasia, and language barriers that affect scoring
- Pupil assessment — always assess pupils alongside GCS (size, equality, reactivity); a fixed dilated pupil with declining GCS indicates herniation risk
- Vital signs — Cushing's triad (hypertension + bradycardia + irregular respirations) indicates rising ICP
Documentation Rules
- Always document individual components — “GCS 10: E3V3M4,” not just “GCS 10.”
- Intubated patients — append “T” to the total and mark verbal as not testable: “GCS 8T: E2VTM6.”
- Non-testable limb (fracture, cast) — document the reason: “M5 right (left NT — cast).”
- Trend over time is more important than a single value — compare to baseline at every shift.
- A GCS drop of ≥ 2 points is a significant change requiring immediate provider notification.
- Use a central stimulus (sternal rub or supraorbital pressure) for unresponsive patients to assess eye and motor responses.
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Teasdale & Jennett / NICE Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →