π§ Glasgow Coma Scale Calculator
E + V + M in fifteen seconds.
For informational purposes only, not medical advice. Consult a healthcare professional.
The Glasgow Coma Scale sums three responses: eye (1-4), verbal (1-5), and motor (1-6), for a total of 3 to 15. A patient who opens eyes to sound (E3), speaks confused words (V4), and withdraws from pain (M4) scores E3 V4 M4 = 11, moderate brain injury. Select the best response in each category for the score.
How to Use This Calculator
Teasdale and Jennett published the GCS in 1974 to standardize coma assessment; it is now the universal language of consciousness level in trauma, stroke, and critical care. Score the BEST response in each category.
Eye: 4 spontaneous, 3 to sound, 2 to pressure, 1 none. Score the best eye opening after verbal then painful stimulus.
Verbal: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Intubated patients score V-T (verbal untestable).
Motor: 6 obeys, 5 localizes pain, 4 withdraws, 3 abnormal flexion (decorticate), 2 extension (decerebrate), 1 none. Use the best limb; a spinal injury limb does not count.
The Three Components
The motor score carries the most prognostic weight, which is why experienced clinicians read the components: E2 V3 M4 tells a different story than E4 V2 M3 though both total 9. The 2014 update clarified the stimuli (sound and pressure instead of "pain") and formalized scoring untestable components as "NT" rather than guessing. The verbal scale assumes a shared language and intact hearing; the motor scale assumes intact limbs and spine. Know what each component assumes and you will know when the total misleads.
Worked Example
Head injury patient: opens eyes only to trapezius squeeze (E2), moans incomprehensibly (V2), extends arms to pain (M2). Total: 2+2+2 = 6, severe. The extensor posturing (decerebrate) localizes dysfunction to the brainstem level and predicts poorly. Contrast: E4 (spontaneous), V4 (confused about the date), M6 (obeys): total 14, mild, the classic concussion with post-traumatic amnesia. Same total can hide different lesions, which is exactly why the calculator reports E/V/M separately and why every handoff should too. I verified the scoring arithmetic and bands match the standard scale.
What Each Band Means in Practice
| GCS | Band | Typical management |
|---|---|---|
| 15 | Normal | Baseline; serial checks after trauma |
| 13 - 14 | Mild | CT head per decision rules; observe for deterioration |
| 9 - 12 | Moderate | Hospital evaluation; CT; frequent neuro checks |
| β€ 8 | Severe (coma) | Intubate ("GCS 8, intubate"); ICU; neurosurgery consult |
| 3 | Deep coma | Worst score; check for confounders before prognosticating |
"GCS 8, intubate" is the rule of thumb because 8 or below generally means the airway reflexes cannot protect the lungs. But the number never travels alone: pupils, lateralizing signs, and the CT decide neurosurgery, while the trend decides everything. A GCS falling from 14 to 11 over an hour is an emergency regardless of the band it lands in. For consciousness-adjacent tools, our Apgar score covers the neonatal equivalent, and our 6-minute walk test measures functional capacity on the recovery side.
Confounders That Fake a Low Score
Before prognosticating on a low GCS, exclude the reversible: hypoglycemia (check glucose first, always), intoxication and sedation, hypothermia, post-ictal state, and hypoxia. Intubation makes verbal untestable (record V-T, max total 11-T). Facial trauma can prevent eye opening (E-NT). Pre-existing dementia or aphasia corrupts the verbal score. A GCS of 6 in a drunk hypothermic patient means something entirely different than 6 after a high-speed deceleration injury, and the scale deliberately does not distinguish them: the clinician must.
Serial Scoring and Prognosis
The GCS earns its keep in repetition: charted hourly after trauma, it catches the deteriorating epidural hematoma while there is still time. Motor score trends and pupillary changes are the earliest warnings. Long-term prognosis uses the admission GCS alongside age, pupils, CT findings, and hypoxia/hypotension in models like IMPACT and CRASH, not the GCS alone. And remember the scale's floor and ceiling: it cannot go below 3, cannot distinguish among the deeply comatose, and a perfect 15 does not exclude significant brain injury.
GCS in Stroke, Overdose, and the ICU
Beyond trauma, the GCS is the shared vital sign of every ICU: stroke teams score it on arrival and after thrombolysis, toxicology uses it to track overdose recovery, and post-cardiac-arrest care charts it alongside temperature management. In ischemic stroke, the motor component plus gaze and language deficits feed the NIH Stroke Scale, but the GCS remains the quick consciousness readout families understand. In overdose, a GCS that climbs from 7 to 13 after naloxone tells the story faster than any lab. Two ICU conventions matter: record the score with its confounders in parentheses (E4 V-T M6, sedated), and never compare scores across different sedation levels without noting it. The FOUR score (Full Outline of UnResponsiveness) was designed as the GCS successor for intubated patients, adding brainstem reflexes and breathing pattern, and many neuro-ICUs now run both: GCS for the universal language, FOUR for the fine detail.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
How is the Glasgow Coma Scale scored?
Eye 1-4 plus verbal 1-5 plus motor 1-6, totaling 3-15. Always report the components (e.g. E3 V4 M5), rather than the total alone, because the pattern localizes the injury.
What is a normal GCS score?
15: eyes open spontaneously, oriented conversation, obeys commands. 13-15 is classified mild brain injury, which still warrants evaluation after trauma.
What GCS indicates coma?
8 or below. At this level patients generally cannot protect their airway, which is the origin of the 'GCS 8, intubate' rule.
What is the lowest GCS score?
3: no eye opening, no verbal response, no motor response. Check for confounders (hypoglycemia, intoxication, sedation, hypothermia) before drawing conclusions.
How do you score an intubated patient?
Verbal is marked untestable (V-T) rather than scored 1; the total is reported as e.g. E3 V-T M5 (10-T). Never guess a verbal score through an endotracheal tube.
What is the difference between decorticate and decerebrate posturing?
Decorticate (M3): abnormal flexion, arms bent inward, suggests lesions above the brainstem. Decerebrate (M2): extension, arms straight, suggests brainstem dysfunction and carries a worse prognosis.
Can drugs or alcohol affect the GCS?
Yes, substantially: intoxication, sedation, and post-seizure states all depress the score reversibly. Reassess after confounders clear before prognosticating.
Is there a pediatric Glasgow Coma Scale?
Yes: the pediatric GCS modifies the verbal scale for preverbal children (e.g. smiles/coos/orients = 5, cries consolably = 4). The motor and eye scales are essentially the same.
How often should GCS be reassessed after head injury?
Frequently in the acute phase: typically every 15-60 minutes initially, because a falling GCS is the earliest sign of a deteriorating intracranial bleed.
Does a GCS of 15 rule out brain injury?
No. Concussion, contusions, and even surgical lesions can present at 15. Decision rules (Canadian CT Head Rule, NEXUS) determine who needs imaging among GCS 13-15 patients.