Chart — Critical Care

Glasgow Coma Scale Interpretation Chart

GCS subscores with criteria and clinical meaning, total score severity ranges, clinically significant change thresholds, and documentation guidance — focused on score interpretation beyond just the numbers.

Educational use only. GCS findings must be interpreted in the full clinical context. Always document subscores (E/V/M), not just the total. Follow institutional protocols for escalation. 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	Criteria	Clinical Interpretation
E4	Spontaneous	Eyes open without any stimulation — best possible eye response.
E3	To voice	Eyes open in response to voice — reduced spontaneous arousal.
E2	To pain	Eyes open only with painful stimulus — significant impairment.
E1	None	No eye opening regardless of stimulation — deep dysfunction or pharmacological sedation.

Verbal Response (V) — Max 5 Points

Score	Criteria	Clinical Interpretation
V5	Oriented	Patient knows person, place, time, situation — highest verbal function.
V4	Confused	Conversational speech but disoriented — impaired higher cortical processing.
V3	Words	Intelligible words but not conversational sentences.
V2	Sounds	Only moans or groans — no recognizable words.
V1	None	No verbal response.
VT	Intubated (T)	Cannot be assessed due to artificial airway — document as VT.

Motor Response (M) — Max 6 Points

Score	Criteria	Clinical Interpretation
M6	Obeys commands	Follows two-step commands — highest motor function.
M5	Localizes pain	Reaches toward or attempts to remove painful stimulus — purposeful movement.
M4	Withdraws from pain	Pulls away from stimulus but does not localize — flexion withdrawal.
M3	Flexion (decorticate)	Abnormal flexion of arms toward body; legs extended — indicates cortical dysfunction.
M2	Extension (decerebrate)	Arms and legs extend with internal rotation — brainstem dysfunction; more severe than decorticate.
M1	None	No motor response to any stimulus.

Total Score Interpretation (GCS 3–15)

Score	Severity	Clinical Meaning
15	Normal	Alert, oriented, obeys commands. GCS 15 is the highest possible score.
13–14	Mild impairment	Minor confusion or lethargy. Alert but some component reduced. Monitor closely for trend.
9–12	Moderate impairment	Decreased consciousness. Confused, inconsistent commands. ICU or step-down monitoring warranted.
≤8	Severe / coma threshold	GCS ≤8 = traditional coma threshold. Intubation often considered. Intensive monitoring required.
3	Minimum score	Deeply comatose or brain dead. E1V1M1 = no eye opening, no verbalization, no motor. Confirm with clinical assessment.

GCS ≤8 = Coma Threshold

A GCS ≤8 traditionally indicates inability to protect the airway and is the threshold for considering intubation. Always document subscores (E/V/M) — a GCS 8 of E2V2M4 differs greatly from E1V1M6.

Clinically Significant GCS Changes

Change	Significance / Action
GCS drops 2+ points	Clinically significant — notify provider, increase monitoring frequency
GCS drops from ≥9 to ≤8	Crosses coma threshold — consider airway protection
Motor drops M6→M5 or lower	Loss of command-following — significant cortical change
E1 + V1 + M1–2	Deeply unresponsive — urgent reassessment; rule out treatable causes
Pupils change simultaneously with GCS drop	Possible herniation — STAT notification

Documentation Best Practices

•Always document GCS with subscores: e.g., GCS 10 (E3V3M4) — the total alone is insufficient.

•For intubated patients: document as GCS [total]T (e.g., 8T) and note verbal is untestable.

•Document the best response in each domain — GCS measures the highest function, not the worst.

•For hemi-paretic patients: use the best limb for the motor score.

•Trend documentation: 'GCS 14 at 0800, 12 at 1000, 10 at 1200' communicates trajectory effectively.

Related Resources

Neuro Assessment and Neuro Checks GuideSystematic bedside neuro check including GCS and deterioration recognition

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Neuro Assessment Quick ReferenceBedside neuro check components, LOC levels, and pupils

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Cranial Nerve Assessment ChartAll 12 cranial nerves with function and bedside testing

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Sedation Scale Comparison ChartRASS and SAS side by side — ranges and score interpretation for sedated patients

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Standards & sources

Fact-checked Jun 20, 2026

This 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 →