Reference — Neurology

Glasgow Coma Scale Reference

Complete GCS reference — eye opening, verbal response, and motor response components with scores, response descriptions, interpretation ranges, and clinical documentation tips.

Educational use only. 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.

Purpose. The Glasgow Coma Scale (GCS) provides an objective, reproducible numeric score (3–15) for level of consciousness. It is used to establish neurological baseline, track trends, triage severity, and communicate across care teams. GCS was originally developed for traumatic brain injury (TBI) but is used broadly in critical care and emergency settings.

GCS at a Glance

Component	Score	Response
Eye Opening (E)	4	Spontaneous
	3	To Voice
	2	To Pain
	1	None
Verbal (V)	5	Oriented
	4	Confused
	3	Words only
	2	Sounds only
	1	None
Motor (M)	6	Obeys commands
	5	Localizes pain
	4	Withdraws
	3	Abnormal flexion (decorticate)
	2	Extension (decerebrate)
	1	None

Component Detail

Eye Opening (E)

Max: 4

Spontaneous

Opens eyes without any stimulus

To Voice

Opens eyes in response to spoken command or voice

To Pain

Opens eyes only in response to painful stimulus (peripheral: nail bed pressure; central: sternal rub)

None

Does not open eyes to any stimulus

If eyes are swollen shut due to trauma or facial edema, document 'NT' (not testable) and note the reason.

Verbal Response (V)

Max: 5

Oriented

Correctly states name, place, and date/time

Confused

Conversational speech but disoriented; answers questions but incorrectly

Words

Produces recognizable single words or phrases, not conversational

Sounds

Makes unintelligible sounds — moans, groans — no recognizable words

None

No verbal response to any stimulus

If patient is intubated or has tracheostomy, document 'T' (e.g., GCS 8T: E3VTM5). Verbal score cannot be assessed for intubated patients.

Motor Response (M)

Max: 6

Obeys Commands

Follows two-step verbal command ('Squeeze my hand... now let go')

Localizes Pain

Purposefully moves hand toward site of painful stimulus (crosses midline toward sternal rub)

Withdrawal

Pulls extremity away from painful stimulus — non-purposeful

Abnormal Flexion (Decorticate)

Stereotyped flexion of arm at elbow; wrist flexion; leg extension — indicates cortical injury

Extension (Decerebrate)

Arm extension, adduction, and internal rotation; leg extension — indicates brainstem injury; worse than decorticate

None

No motor response to any stimulus

Use the BEST motor response observed in any limb. Central pain stimulus (sternal rub or supraorbital pressure) for unresponsive patients.',

Score Interpretation

Score	Severity	Clinical Implications
15	Normal	Fully conscious; baseline comparison
13–14	Minor impairment	Mild TBI or early encephalopathy; close monitoring
9–12	Moderate	Moderate TBI; ICU-level monitoring; consider intubation risks
≤8	Severe	Coma; compromised airway protective reflexes; strong indication for intubation
3	Lowest possible	Complete unresponsiveness — not necessarily brain death (requires formal testing)

GCS ≤8 = consider airway management. GCS 8 = “intubate” is the clinical teaching point — assess airway protection and act accordingly.

Documentation Tips

✦Always document individual component scores, not just the total — 'GCS 10: E3V3M4' is far more informative than 'GCS 10.'
✦Intubated patients: document 'T' for verbal — 'GCS 8T: E2VTM6' indicates verbal cannot be assessed.
✦Non-testable components: document 'NT' with explanation — 'E1NT: eyes swollen shut from orbital fracture.'
✦Trend matters more than a single number — always compare to the patient's documented baseline.
✦A drop of ≥2 GCS points = significant change. Notify provider and reassess immediately.
✦Document the stimulus required and the specific response obtained, not just the number.

Related Resources

Neurological Assessment FundamentalsLOC, orientation, pupils, motor — bedside neuro assessment

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Increased Intracranial PressureICP monitoring and GCS trends as early warning signs

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Brain Herniation ReferenceProgressive GCS decline as a herniation warning sign

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Glasgow Coma Scale Scoring ChartE, V, and M subscores with criteria and total-score severity at a glance

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Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). 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 →