Glasgow Coma Scale

Background

Distribution of GCS in traumatic brain injury

Eye Opening	Verbal	Motor
		6: Obeys commands
	5: Oriented	5: Localizes to pain
4: Spontaneously opens	4: Confused speech	4: Withdraws from pain (normal flexion)
3: Opens to command	3:Inappropriate words	3: Decorticate posturing (abnormal flexion)
2: Opens to pain	2: Incomprehensible sounds	2: Decerebrate posturing (extension)
1: Does not open	1: No response	1: No response

Eye Opening	Verbal	Motor
		6: Normal spontaneous movement
	5: Smiles, coos, babbles	5: Withdraws to touch
4: Opens eyes spontaneously	4: Irritable, crying (but consolable)	4: Withdraws to pain
3: Opens eyes to speech only	3:Inconsolable crying or crying only in response to pain	3: Abnormal flexion to pain (Decorticate response)
2: Opens eyes to pain only	2: Moans in response to pain	2: Abnormal extension to pain (Decerebrate response)
1: Does not open eyes	1: No response	1: No response

Note:

For Motor score 4, pain is defined flat, fingernail pressure (often performed with the barrel of a pencil).
For Motor scores 2 and 3, pain is defined by pressing hard on the supraorbital notch. If this unsuccessful, sternal pressure may also be attempted.

Holmes JF, Palchak MJ, MacFarlane T, et al. Performance of the pediatric glasgow coma scale in children with blunt head trauma. Acad Emerg Med. 2005 Sep;12(9):814-9.
James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann. 1986 Jan;15(1):16-22.

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