GCS Score: How to Score Eye, Verbal, and Motor Responses

Chart every GCS score as eye, verbal, and motor components, then add the total (3 to 15). The components carry more information than the sum.

How is the GCS score calculated?

Score eye opening 1 to 4, verbal 1 to 5, and motor 1 to 6, then add them. Write the result as E3 V4 M5 (total 12) so the next clinician can trend each component.

The Glasgow Coma Scale site lists the descriptors in rank order, and each score equals its rank from the bottom.

Use the six-point motor scale, which the Glasgow group recommends for all purposes because it separates normal from abnormal flexion. The 2014 revision also swapped "pain" for "pressure" in the eye scale (Glasgow structured assessment).

How do you elicit the motor response?

Use a central stimulus to test for localising and a peripheral stimulus to look for flexion or extension. The Glasgow structured assessment sets the technique:

• Central: press the trapezius or the supraorbital notch, using a standard sequence of graded intensity.
• Peripheral: press the fingernail bed, rotating across fingers over time.
• Avoid: sternal knuckle rubbing, which it strongly discourages because of bruising and hard-to-interpret responses. It also does not recommend pressure behind the jaw for routine use.
• Suspected spinal injury: the FAQ suggests adapting the exam toward tongue and eye movements instead of hand movements.

How do you document GCS in an intubated or sedated patient?

Record the component you can't test as NT and keep assessing the rest. The Glasgow group advises against reporting a total when any component is not testable.

The Glasgow FAQ states that NT replaces a score of 1, because a 1 would imply more impairment than you can show. Verbal is the usual casualty in intubation, so a chart entry reads E2 VNT M4. The same page describes a temporary reversal of sedation and paralysis (a wake-up test) to judge the underlying level of consciousness. Check how your flowsheet handles NT, because a forced numeric V creates a spurious total.

What do the total, severity bands, and GCS-P tell you?

Use the total to describe groups and the components to describe the patient. Bands are triage shorthand, and they disagree at the edges.

The Glasgow FAQ lists mild as 13 to 15 and moderate as 9 to 12, and describes severe as below 8. WikEM lists 14 to 15 as mild, 9 to 13 as moderate, and 3 to 8 as severe, so 13 changes category by reference. Name the source your protocol uses.

A total of 8 can come from E4 V1 M3 or E2 V2 M4, which describe different patients. Teasdale and colleagues, in a 2014 Lancet Neurology review, conclude that the three components describe individual patients best, and the FAQ adds that the sum carries less prognostic information than the components.

GCS-P subtracts a pupil reactivity score (2 when both pupils are unreactive, 1 when one is, 0 when neither is) from the total, giving a range of 1 to 15 (Brennan, Murray, and Teasdale, 2018). Their example: E1 V1 M4 gives a GCS of 6, and with neither pupil reactive the GCS-P is 4, with mortality rising from 29% to 39% (Glasgow GCS-P page). It serves trauma severity and research. I found no source stating that it replaced standard GCS charting, so keep recording E, V, and M and chart pupils as their own finding.

Where does the GCS score fall short?

The 2014 review states that predictions should come from multivariate models that include other variables (Teasdale et al., 2014). Raters drift when stimulus, wording, and confounders such as sedation vary, and the Glasgow FAQ says a standardised approach improves reliability. This article does not cover pediatric scoring (the Glasgow site and WikEM describe age-adjusted descriptors), inter-rater agreement percentages, or local severity thresholds. I checked the Glasgow group's materials on 2026-10-10 and found no revision newer than the 2014 update and the 2018 GCS-P work, so confirm with your institution's current protocol.