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Glasgow Coma Scale (GCS): how to score it
The Glasgow Coma Scale (GCS) scores level of consciousness from 3 to 15 by adding three parts: eye opening (1 to 4), verbal response (1 to 5) and motor response (1 to 6). A total of 13 to 15 is mild, 9 to 12 moderate and 8 or less severe brain injury.
How to score the GCS, step by step
- Check eye opening first. Watch whether the eyes open on their own, then to your voice, then to pressure (such as fingertip pressure).
- Check the verbal response. Ask the client their name, where they are and what month it is.
- Check the motor response. Ask the client to obey a command (such as "hold up two fingers"). If they cannot, apply pressure and watch how they move.
- Score the best response in each part, then add the three numbers.
- Record each part, not only the total (for example E3 V4 M6 = 13), so the next nurse can see what changed.
GCS scoring table
| Part | Response | Points |
|---|---|---|
| Eye opening (E) | Opens eyes spontaneously | 4 |
| Opens eyes to sound (voice) | 3 | |
| Opens eyes to pressure | 2 | |
| No eye opening | 1 | |
| Verbal (V) | Oriented (name, place, time) | 5 |
| Confused but talking in sentences | 4 | |
| Words (inappropriate words) | 3 | |
| Sounds (moans, groans) | 2 | |
| No verbal response | 1 | |
| Motor (M) | Obeys commands | 6 |
| Localizes (moves toward the pressure to remove it) | 5 | |
| Normal flexion (withdraws from pressure) | 4 | |
| Abnormal flexion (decorticate posturing) | 3 | |
| Extension (decerebrate posturing) | 2 | |
| No motor response | 1 |
What the total means
- 15: fully awake and oriented (the highest score).
- 13 to 15: mild brain injury.
- 9 to 12: moderate brain injury.
- 8 or less: severe brain injury. The client may not be able to protect their airway ("8 or less, intubate" is a memory aid, not a rule).
- 3: the lowest possible score. A GCS can never be 0.
Worked examples
- Opens eyes when you speak (E3), confused about the date (V4), follows commands (M6): GCS 13, mild.
- Opens eyes only to pressure (E2), moans (V2), withdraws from pressure (M4): GCS 8, severe.
- Intubated client who opens eyes spontaneously (E4) and obeys commands (M6): record E4 VT M6. The verbal part cannot be tested, so write T instead of guessing a number.
Common mistakes
- Reporting only the total. E1 V5 M6 and E4 V3 M5 are both 12 but mean very different things.
- Scoring a verbal 1 for an intubated client. Mark it not testable (T).
- Missing a trend. Compare every score with the last one and report a drop right away, because it can signal rising intracranial pressure.
NCLEX tip: On the NCLEX, a falling GCS or a new change in level of consciousness is often the earliest sign of increased intracranial pressure. The priority is to notify the provider, not to wait and recheck later.
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Frequently asked questions
What is a normal GCS score?
15 is normal: the client opens their eyes on their own, is oriented and obeys commands.
What GCS score means intubation?
A GCS of 8 or less is considered severe and often means the client cannot protect their airway, so intubation is usually considered. Follow the provider's assessment and your facility's protocol.
What is the lowest GCS score?
3, one point in each of the three parts. A GCS cannot be 0.
Keep studying
Sources
- Glasgow Coma Scale, StatPearls, NCBI Bookshelf
- Glasgow Coma Scale, glasgowcomascale.org
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.