Stroke Training and Awareness Resources (STARs)


Case 4: Maisie

Glasgow coma scale

Background information on the Glasgow coma scale (GCS)

The Glasgow coma scale (GCS) is a is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment.

Three types of response are measured:

  • Best motor response – maximum score of 6
  • Best verbal response – maximum score of 5
  • Eye opening – maximum score of 4

The lowest score for each category is 1, therefore the lowest score possible is 3 (= no response to pain + no verbalisation + no eye opening). A healthy person will score 15/15.

  • A patient with a GCS less than or equal to 8 requires the early involvement of an anaesthetist or critical care physician to provide appropriate airway management.
  • Reduction in motor score by one or an overall deterioration of two is significant and should be reported
  • Differences in GCS scores of two or more have been reported on the same patients by different practitioners. This reinforces that clinical decisions should not be solely based upon GCS but be used as a component of neurological function.

Glasgow coma scale

Score
Eye opening spontaneously
to speech
to pain
none
4
3
2
1
Verbal response orientated
confused
inappropriate
incomprehensible
none
5
4
3
2
1
Motor response obeys commands
localises to pain
withdraws from pain
flexion to pain
extension to pain
none
6
5
4
3
2
1
Maxiumum score 15

Ref: Nursing Times Neurological Assessment Part 4 – GCS 2 29th July 2008

Page last reviewed: 23 Apr 2020