Glasgow Coma Scale (GCS)
Coma severity based on Eye (4), Verbal (5), and Motor (6) criteria.
- Note that this calculator has been updated as of May 2019 in order to add more supporting references and to distinguish between the Glasgow Coma Score (total score, only applicable when all three components are testable) and the Glasgow Coma Scale (component scores, applicable if any of three components is not testable).
- For preverbal children (≤2 years of age), consider using the Pediatric Glasgow Coma Scale.
Advice
The GCS score can be indicative of how critically ill a patient is.
- Trauma patients presenting with GCS <15 warrant close attention and reassessment.
- A declining GCS is concerning in any setting and should prompt assessment of the airway and possible intervention.
Conversely, a GCS of 15 should not be taken as an indication that a patient (trauma or medical) is not critically ill. Decisions about the aggressiveness of the management and treatment plans should be made based on clinical presentation and context and not in any way overridden by the GCS score.
Management
- Clinical management decisions should not be based solely on the GCS score in the acute setting.
- If a trauma patient has a GCS ≤8 and there is clinical concern that they are unable to protect their airway or that they have an expected worsening clinical course based on exam or imaging findings, then intubation can be considered.
- In any patient, a rapidly declining or waxing and waning GCS is concerning and intubation should be considered in the context of the patient's overall clinical picture.
Critical Actions
- Although it has been adopted widely and in a variety of settings, the GCS score is not intended for quantitative use.
- Clinical management decisions should not be based solely on the GCS score in the acute setting.
From the creators of the GCS:
“We have never recommended using the GCS alone, either as a means of monitoring coma, or to assess the severity of brain damage or predict outcome.” (Teasdale 2014)