Glasgow Coma Scale (GCS) Calculator
The Glasgow Coma Scale (GCS), introduced by Teasdale and Jennett in 1974, is a bedside neurological score that rapidly quantifies the severity of acute brain injury or altered consciousness. Pick the best response observed in each of three components (eye-opening, verbal, motor); the tool sums them to a total (3–15) and bands it as mild / moderate / severe per the Brain Trauma Foundation convention. It is used everywhere from emergency departments and intensive care to prehospital and trauma triage.
Pick all three responses (eye 1–4, verbal 1–5, motor 1–6).
GCS total
15 / 15
Mild
E4 V5 M6
Severity band (Brain Trauma Foundation)
3–8 Moderate
9–12 Mild
13–15
Original scale: Teasdale & Jennett, Lancet 1974. For clinical reference only — not a substitute for medical judgement.
Formula
GCS = E (eye 1–4) + V (verbal 1–5) + M (motor 1–6); total 3–15 Severity (BTF): 3–8 severe, 9–12 moderate, 13–15 mild
- · Original scale: Teasdale G, Jennett B. Lancet 1974;304(7872):81-4.
- · Eye (E): 4 spontaneous, 3 to voice, 2 to pain, 1 none.
- · Verbal (V): 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none.
- · Motor (M): 6 obeys commands, 5 localises pain, 4 withdraws from pain, 3 abnormal flexion (decorticate), 2 abnormal extension (decerebrate), 1 none.
- · Severity follows the Brain Trauma Foundation convention: severe 3–8, moderate 9–12, mild 13–15. Minimum 3 (deep coma); maximum 15 (alert and oriented).
- · For intubated patients the verbal component scores 1 and the total is annotated with a "T" (e.g. 8T); this tool assumes a non-intubated patient. Document untestable components (sedation, intoxication, periorbital swelling, aphasia) as "NT" rather than scoring 1.
- · For clinical reference only — not a diagnostic tool. Treatment decisions must be made by qualified clinicians using full clinical judgement.
Frequently asked
How does GCS compare to the FOUR Score and AVPU? When should I use each?
AVPU (Alert / Voice / Pain / Unresponsive) is the fastest four-point screen — popular in prehospital care, mass-casualty triage and quick reassessment, but it has very low resolution. GCS is finer (13 possible totals from 3 to 15) and has been the bedside standard in emergency and trauma care for half a century; it tracks trends well. The FOUR Score (Wijdicks, Mayo Clinic, 2005) scores four 0–4 components — eye, motor, brainstem reflexes and respiration — addressing two GCS weak spots: no verbal score in intubated patients, and no brainstem assessment. It is best for deeply comatose ICU patients. Rule of thumb: AVPU or GCS for prehospital / ED triage; FOUR Score for intubated or critically ill ICU patients; GCS remains the primary score in trauma registries and most research.
How do I score GCS in an intubated or intoxicated patient?
For intubated patients the verbal component is conventionally scored as 1 and the total is annotated with a "T" (e.g. 8T, "verbal not testable due to intubation") so the next clinician knows the low verbal score reflects an airway, not a neurological deficit. When a component is genuinely unassessable — sedation, intoxication, paralytics, severe periorbital oedema — modern practice (GCS-Pupils 2018 update) is to document it as NT (Not Testable) rather than score 1, which would artificially inflate severity. In practice, record context alongside the score (e.g. "E1 V1T M5, sedated, propofol infusion") so the team can interpret the trend.
Is GCS 8 really the "intubation threshold"? How authoritative are the severity bands?
The "GCS ≤ 8 = intubate" rule (popularised by the American Association of Neurological Surgeons / BTF 1995 trauma guidelines) is a useful reminder that loss of airway reflexes is likely, but recent systematic reviews (Kung et al. 2022 and others) point out the threshold comes from observational extrapolation, not strong RCT evidence — airway patency, gag reflex, expected course and transport distance all still matter. Likewise, the severe 3–8 / moderate 9–12 / mild 13–15 bands trace back to early trauma-registry statistics (Rimel/Jennett, 1980s) and have been adopted by the WHO, ACS-COT and ATLS, but the mortality gradient between, say, 13 and 12 is continuous rather than a cliff. Treat the bands as a triage and epidemiology shorthand — not a substitute for clinical judgement.
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