Glasgow Coma Scale (GCS) 2025: Complete Guide to Consciousness Assessment
The Glasgow Coma Scale (GCS) is the gold standard for assessing level of consciousness in patients with brain injury, stroke, intoxication, or altered mental status. Developed in 1974 by Teasdale and Jennett, it scores three components: Eye (E), Verbal (V), and Motor (M) responses. Total score ranges from 3 (deep coma) to 15 (fully alert). Our GCS Calculator supports adults, children, and infants with age-appropriate criteria. This guide covers scoring, interpretation, limitations, and clinical use.
What is the Glasgow Coma Scale?
GCS objectively measures brain function by evaluating:
- Eye Opening: Response to stimuli (4 points max)
- Verbal Response: Speech clarity and orientation (5 points max)
- Motor Response: Movement in response to pain or command (6 points max)
Total GCS = E + V + M
GCS Scoring Tables
Adult / Adolescent
| Score | Eye (E) | Verbal (V) | Motor (M) |
|---|---|---|---|
| 6 | - | - | Obeys commands |
| 5 | - | Oriented | Localizes pain |
| 4 | Spontaneous | Confused | Withdraws from pain |
| 3 | To speech | Inappropriate words | Abnormal flexion |
| 2 | To pain | Incomprehensible sounds | Extension |
| 1 | None | None | None |
Pediatric GCS (1–12 years)
Verbal and motor criteria adjusted for developmental stage.
Infant GCS (<1 year)
Uses crying, movement, and eye tracking.
GCS Severity Classification
| GCS Score | Severity | Prognosis |
|---|---|---|
| 13–15 | Mild | Good recovery likely |
| 9–12 | Moderate | May need rehab |
| 3–8 | Severe | High risk of disability/death |
How to Perform GCS Assessment
- Eye: Observe spontaneous opening → call name → apply pressure
- Verbal: Ask "What is your name?" → "Where are you?"
- Motor: Ask to squeeze hands → apply nailbed pressure
- Record best response in each category
Pediatric Modifications
- Infants: "Coos, babbles" = 5; "Irritable cry" = 3
- Children: "Smiles, follows objects" = 5
Limitations of GCS
- Cannot assess intubated patients (record "T")
- Affected by sedation, paralysis, alcohol
- Not valid in aphasia, deafness, or facial trauma
- Use APGAR for newborns
GCS in Clinical Practice
- Trauma triage: GCS ≤8 → intubate
- Stroke: Track deterioration
- ICU: Hourly monitoring
- Prognosis: GCS + age + pupil response = outcome prediction
Common Mistakes
- Testing painful stimuli on injured limb
- Accepting grimacing as verbal response
- Not documenting "T" for intubated patients
Advanced Tips
- Pair with Symptom Checker
- Use MAP for shock assessment
- Trend GCS over time, not single value
FAQs
What is a good GCS score? 15 is normal. 13–15 = mild injury.
Can GCS be 0? No. Minimum is 3 (1+1+1).
Is GCS used in children? Yes, with modified criteria.
Conclusion
The GCS remains the cornerstone of neurological assessment 50 years after its creation. Our 2025 GCS Calculator provides instant, accurate scoring across all ages. Use it to support — not replace — clinical judgment. Always consult a physician for interpretation and management.
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