Neurology AssessmentEvidence-Based Golden Standard
Glasgow Coma Scale (GCS)
Standardized objective assessment of impaired consciousness from three responses — eye, verbal, motor. Score 3 (deep coma) to 15 (fully alert).
GCS = Eye (1–4) + Verbal (1–5) + Motor (1–6), total 3–15
Eyes: 4 spontaneous · 3 to speech · 2 to pain · 1 none
Verbal: 5 oriented · 4 confused · 3 words · 2 sounds · 1 none
Motor: 6 obeys commands · 5 localizes pain · 4 withdraws · 3 flexion · 2 extension · 1 none
Severity: 13–15 mild · 9–12 moderate · ≤8 severe (airway protection indicated)
Published Clinical Benchmark Cases
Clinical Parameters & Inputs
Computed OutputMild Head Injury (GCS 15)
15/ 15
Diagnostic Interpretation
GCS is 15 (E4 V5 M6), mild impairment. Monitor for deterioration; CT head if red flags (LOC, amnesia, vomiting, anticoagulation, focal deficit) are present.
Calculation Breakdown
Component Scores
Eye 4 + Verbal 5 + Motor 6 =GCS 15 / 15
Severity Band
13–15 mild · 9–12 moderate · ≤8 severe =Mild Head Injury (GCS 15)
Clinical Decision Pearls
- Always record the GCS in the component form E_V_M_ plus pupil size/reactivity — the trend is more informative than a single total.
- A GCS ≤8 classically signals loss of airway reflexes and mandates intubation for protection.
Limitations & Confounders
- Cannot be scored in the intubated, sedated, or profoundly intoxicated patient — record as "Vt" and rely on motor score.
- Inter-rater variability is real; score the best motor response.
Evidence & Citations
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;304(7872):81-84.