Head Injury: Using the GCS

Adults
Children: <4 years
Calculating the GCS

Normal consciousness: GCS = 15/15

ADULTS:

E: EYE OPENING

• 4. Spontaneous
• 3. To speech
• 2. To pain
• 1. None

V: VERBAL RESPONSE

• 5. Oriented
• 4. Confused
• 3. Inappropriate words
• 2. Incomprehensible sounds
• 1. None

(If ventilated or intubated, record T)

M: MOTOR RESPONSE

• 6. Obeys commands
• 5. Localises pain
• 4. Normal flexion (withdraws)
• 3. Abnormal flexion (decorticate)
• 2. Extension (decerebrate)
• 1. None

CHILDREN: <4 years

E: EYE OPENING

• 4. Spontaneous
• 3. To speech
• 2. To pain
• 1. None

V: VERBAL RESPONSE

• 5. Alert, babbles, coos, words or sentences to usual ability
• 4. Less than usual ability and/or spontaneous irritable cry
• 3. Cries inappropriately
• 2. Occasionally whimpers or moans
• 1. None

(If ventilated or intubated, record T)

A grimace alternative to verbal responses should be used in preschool or intubated children.

G: GRIMACE

• 5. Spontaneous normal facial/oromotor activity
• 4. Less than usual spontaneous ability or response to touch stimuli only
• 3. Vigorous grimace to pain
• 2. Mild grimace to pain
• 1. No response

M: MOTOR

• 6. Obeys commands or performs normal spontaneous movements
• 5. Localises pain or withdraws to touch
• 4. Withdraws from pain
• 3. Flexion to pain (decorticate)
• 2. Extension to pain (decerebrate)
• 1. None

Calculating the GCS:

GCS score = (E+M+V)

Best possible score = 15; worst possible score = 3

• Describe the 3 individual components (eye-opening, verbal response and motor response) in all communications and record scores for each modality
• Base total score on a sum of 15 (for example 13/15)
• Include a grimace alternative to the verbal score in the paediatric version to allow scoring for pre-verbal children