What is a normal GCS score?

A normal GCS score is 15, indicating full consciousness with spontaneous eye opening (E4), oriented verbal responses (V5), and obeying motor commands (M6). GCS 15 rules out significant impairment of consciousness.

How is the GCS scored in intubated patients?

In intubated patients, the verbal component cannot be assessed and is recorded as "NT" (not testable) or "1T". The score is reported as E_V(NT)M_ with a total noted as the sum of testable components only. The motor component alone (GCS-M) has been shown to have similar prognostic value to the full GCS.

What is the GCS-Pupils score?

The GCS-Pupils (GCS-P) score subtracts a Pupil Reactivity Score (PRS) from the GCS total: GCS-P = GCS − PRS. PRS = 0 (both reactive), 1 (one reactive), 2 (neither reactive). GCS-P ranges from 1–15 and has improved prognostic accuracy over GCS alone for traumatic brain injury outcomes.

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Glasgow Coma Scale (GCS)

Assess level of consciousness using eye, verbal, and motor responses. Score range: 3–15.

Eingaben

Eye Opening (E)

Verbal Response (V)

Motor Response (M)

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Select all three components to calculate GCS.

Severe (≤ 8)Coma — consider intubation

Moderate (9–12)Altered consciousness

Mild (13–15)Minor injury / normal

Haftungsausschluss: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteil.

Anwendung

The GCS is used to assess and communicate the level of consciousness in patients with acute brain injury. It is a core component of trauma assessment and serial neurological monitoring.

Clinical pearls

GCS ≤ 8 is the classic threshold for endotracheal intubation for airway protection.
Always report the component scores (E + V + M) rather than just the total — a GCS of 8 as E2V2M4 differs clinically from E4V1M3.
The motor component is the most predictive of outcome in TBI.
GCS is unreliable in intubated, sedated, or paralyzed patients. Document "NT" (not testable) for untestable components.

References

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81-84.
Teasdale G, et al. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13(8):844-854.

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Über dieses Tool

What Is the Glasgow Coma Scale?

The Glasgow Coma Scale (GCS) is a clinical tool developed in 1974 by Teasdale and Jennett at the University of Glasgow to provide a reliable, standardized method for assessing impaired consciousness. It evaluates three independent components: eye opening (1–4), verbal response (1–5), and motor response (1–6), yielding a total score from 3 (deep coma) to 15 (fully alert). The GCS has become the most widely used consciousness assessment tool worldwide and is integrated into trauma protocols, ICU monitoring, and prognostic scoring systems such as APACHE II and the Trauma Score.

How to Score the GCS

Each component is scored based on the best response observed. For eye opening, spontaneous opening scores 4, opening to voice scores 3, opening to pressure (previously "pain") scores 2, and no response scores 1. Verbal response ranges from oriented conversation (5) to no vocalization (1). Motor response ranges from obeying commands (6) through localizing pain, normal flexion withdrawal, abnormal flexion (decorticate), extension (decerebrate), to no response (1). The 2014 update replaced "to pain" with "to pressure" for standardization.

Clinical Interpretation

GCS scores are classified as severe (3–8), moderate (9–12), or mild (13–15). A GCS ≤ 8 is the traditional threshold for considering endotracheal intubation for airway protection in head-injured patients. Serial GCS measurements are more informative than a single reading — a declining GCS suggests clinical deterioration requiring urgent intervention. The motor component alone (GCS-M) has been shown to have similar prognostic value to the full GCS in predicting outcomes after traumatic brain injury, making it particularly useful when verbal assessment is not possible (e.g., intubated patients).

🔑 Klinische Hinweise

Always report component scores (e.g., E3V4M5 = 12) — composite scores obscure important clinical information.
GCS ≤ 8 = consider intubation; GCS ≤ 13 in head trauma = CT scan indicated per NICE guidelines.
Confounders include alcohol, sedatives, paralytic agents, orbital swelling, and aphasia — document these when scoring.
The GCS-Pupils score (GCS minus pupil reactivity penalty) has improved prognostic accuracy over GCS alone.

Schlüsselreferenzen

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81-84.
Teasdale G, et al. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13(8):844-854.
Brennan PM, et al. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score. J Neurosurg. 2018;128(6):1612-1620.

Formel zuletzt überprüft: Februar 2026