Scores eye opening, verbal and motor response in adults and children who talk, for a total from 3 to 15 with the components shown.
Result
Choose the best response in each of the three groups.
Sources
2 studies
2
studies
13,638
citations
18,281
PubMed papers
Evidence
Known limitations
A review of 40 years of use: the scale is used worldwide in practice and research, and individual patients are best described by the three components, with the total kept for describing groups, and predictions should be made only in combination with other variables.
Lancet Neurol: Journal Metrics Score 15.4, Q1 · cited 1,109 times
In 15,900 patients with traumatic brain injury from the CRASH trial and the IMPACT database, GCS minus the number of unreactive pupils predicted outcome as well as more complex models; mortality was 74% at GCS-P 1 against 51% at GCS 3.
J Neurosurg: Journal Metrics Score 2.9, Q1 · cited 222 times
The original gcs paper has been cited 13,638 times, and 18,281 PubMed articles mention the Glasgow Coma Scale in their title or abstract. Citation counts from OpenAlex and article counts from PubMed, retrieved November 12, 2026. Journal Metrics Scores and quartiles are from this site’s current release; follow the journal name for details.
After the result
8 or less · 9 to 12 · 13 to 15
Severe: airway, urgent imaging and specialist input. Moderate: imaging, close observation and senior review. Mild: repeat the score and use a head injury rule.
Next steps
Avoid common errors
5 common errors to avoid
and 3 more
Before you use the result
1Sedation, alcohol and drugs
Sedatives, opioids and alcohol can lower the score, and neuromuscular blockers make it untestable rather than low. Score before sedation where possible and record what was given. Do not attribute a low score to alcohol or drugs until brain injury and other causes have been excluded.
2Intubation and local factors
An endotracheal tube, swollen eyelids, a spinal cord injury or aphasia make some responses untestable. Record NT or T and the reason, not 1.
3Wrong stimulus
A peripheral stimulus can produce a spinal withdrawal that looks like flexion; use central pressure to judge localizing.
4Only the total
Report E, V and M. The same total of 10 can be E2 V3 M5 or E4 V1 M5, which are different patients.
5Preverbal children
A child who cannot talk or follow commands is underscored on the adult wording; use the pediatric version.
Formula
Eye (1 to 4) + best verbal (1 to 5) + best motor (1 to 6) = 3 to 15. GCS-Pupils = total − unreactive pupils (0 to 2).
E (1–4) + V (1–5) + M (1–6)
Eye (1 to 4) + best verbal (1 to 5) + best motor (1 to 6) = 3 to 15. GCS-Pupils = total − unreactive pupils (0 to 2).
The scale
| Score | Response | What to look for |
|---|---|---|
| 4 | Spontaneous | Eyes open before any stimulus. |
| 3 | To sound | Eyes open after a spoken or shouted request. |
| 2 | To pressure | Eyes open after fingertip pressure. |
| 1 | None | No eye opening, with no interfering factor. |
| Score | Response | What to look for |
|---|---|---|
| 5 | Oriented | Correctly gives name, place and date. |
| 4 | Confused | Not oriented, but communicates coherently. |
| 3 | Words | Intelligible single words. |
| 2 | Sounds | Only moans or groans. |
| 1 | None | No audible response, with no interfering factor. |
| Score | Response | What to look for |
|---|---|---|
| 6 | Obeys commands | Obeys a two-part request. |
| 5 | Localizing | Brings a hand above the clavicle towards a stimulus on the head or neck. |
| 4 | Normal flexion | Bends the arm at the elbow rapidly; features not predominantly abnormal. |
| 3 | Abnormal flexion | Bends the arm at the elbow; features clearly abnormal (decorticate). |
| 2 | Extension | Extends the arm at the elbow (decerebrate). |
| 1 | None | No movement in arms or legs, with no interfering factor. |
Wording follows the structured approach of Teasdale and colleagues (2014). Not testable components (an endotracheal tube, swollen eyes) are recorded as NT or T, not as 1. Severity of traumatic brain injury by total: 3 to 8 severe, 9 to 12 moderate, 13 to 15 mild.
Origin
Best response
GCS-Pupils
Test cases
4 published cases, each also a test case
4 published cases; the calculator reproduces every score.
Worked examples
A 52-year-old man had four days of fever, headache, vomiting and altered mental status. On arrival his GCS was 8 (E2V2M4), with neck stiffness and sluggishly reactive pupils; tuberculous meningitis with ventriculitis was diagnosed.
“showed a Glasgow Coma Scale (GCS) score of 8 (E2V2M4)”
Sluggish pupils still react, so GCS-Pupils is also 8. A score of 8 is the usual threshold for coma; he was intubated on day 3 for a falling GCS (E1V2M4, a total of 7), respiratory distress and desaturation.
Entered as: Eye opening: To pressure (2); Best verbal response: Sounds (2); Best motor response: Normal flexion (4); Pupil reactivity (optional): Both react to light (−0).
Source: Misra G et al., Cureus 2025 (PubMed · Free full text · DOI)
A 75-year-old man on aspirin fell backward from a ladder about 3 feet high, with brief loss of consciousness. CT showed subarachnoid blood and bilateral acute on chronic subdural hematomas; four hours later his GCS had fallen to 10 (E2V3M5), localizing to pain on the right with no response on the left.
“GCS declined to 10 (E2V3M5) with the motor examination notable for localization to pain on the right and absent response on the left”
The motor score uses the better side: localizing on the right scores 5, even though the left arm did not move. A fixed right pupil developed at the same time, so GCS-Pupils is 9.
Entered as: Eye opening: To pressure (2); Best verbal response: Words (3); Best motor response: Localizing (5); Pupil reactivity (optional): One pupil unreactive (−1).
Source: Zach RV et al., Surg Neurol Int 2026 (PubMed · Free full text · DOI)
A 44-year-old man with a family history of intracranial aneurysms had a severe headache followed by loss of consciousness. Intubated, he had no eye opening, no left-sided movement and weak localizing on the right, a GCS of 7T (E1VTM5); CT showed subarachnoid blood and a large right intracerebral hematoma.
“He had a Glasgow Coma Scale (GCS) score of 7T (E1VTM5)”
The report writes 7T, counting the untestable verbal response as 1. The calculator shows the components without a total, as the Glasgow team advises.
Entered as: Eye opening: None (1); Best verbal response: Not testable (T); Best motor response: Localizing (5); Pupil reactivity (optional): Not assessed.
Source: Mangat D et al., J Neurol Surg Rep 2026 (PubMed · Free full text · DOI)
A 79-year-old woman with severe lithium toxicity had prolonged impaired consciousness. On day 13 she recovered to a GCS of 11 (E4V3M4) and could say her name; by day 21 she scored 14 (E4V4M6).
“she recovered to a GCS score of 11 (E4V3M4) on the 13th day”
Eyes open spontaneously while speech and movement remain impaired: the total alone (11) does not show that pattern, which is why the components are reported.
Entered as: Eye opening: Spontaneous (4); Best verbal response: Words (3); Best motor response: Normal flexion (4); Pupil reactivity (optional): Not assessed.
Source: Ueda S et al., Cureus 2025 (PubMed · Free full text · DOI)
FAQ
7 questions and answers
and 5 more answers
Questions
Add the best eye opening (1 to 4), the best verbal response (1 to 5) and the best motor response (1 to 6), for a total of 3 to 15. A patient who opens the eyes to pressure (2), makes only sounds (2) and flexes normally to pressure (4) scores 8, written E2 V2 M4.
In head injury, 3 to 8 is severe, 9 to 12 moderate and 13 to 15 mild. A score of 8 or less is also the usual working definition of coma. A score below 15 is not normal, and a score of 15 does not exclude an intracranial injury.
The verbal response cannot be tested, so it is recorded as T (or NT) and the eye and motor scores are reported with it, for example E1 VT M5. The Glasgow team advises against a total when a component is not testable. Many charts write 7T, counting the verbal response as 1; a score with T cannot be compared with a full total.
The same total can come from very different findings, and the motor score carries the most information about outcome. Teasdale and colleagues (2014) recommend describing individual patients by the three components and keeping the total for describing groups.
GCS-P is the GCS total minus the number of pupils that do not react to light (0, 1 or 2), giving a range of 1 to 15. In 15,900 patients with traumatic brain injury, it carried more information about outcome than the GCS alone; at GCS-P 1 mortality was 74%, compared with 51% at a GCS of 3 (Brennan 2018).
Fingertip pressure for eye opening and flexion, and trapezius pinch or supraorbital notch pressure for localizing, applied for up to 10 seconds. Avoid supraorbital pressure if there may be a facial fracture. Use a physical stimulus only when there is no response to spoken or shouted requests.
Normal flexion (4) is a rapid, variable bending of the arm at the elbow, with the arm moving away from the body. Abnormal flexion (3) is slow and stereotyped, with the arm brought across the chest, the forearm and wrist rotating inward and the thumb across the palm, the decorticate posture. Extension (2) straightens the arm at the elbow.
Further reading
7 references with PubMed and DOI links
7
references
4
free full text
From Teasdale G et al., Lancet 1974 to the newest case reports.
References
Contributed by Dr. Meng Zhao (MD · Former Neurosurgeon · Medical AI Researcher), from the original publications listed here. Last updated November 12, 2026. LinkedIn
The calculator code is tested against every worked example on this page before each release.
This calculator supports, and does not replace, clinical judgment. It is meant for healthcare professionals and is not medical advice for patients. Report an error through the contact page.
clinical grade of aneurysmal subarachnoid hemorrhage, I to V.
total calcium adjusted for albumin, in mg/dL or mmol/L.
stroke severity from 15 bedside items, 0 to 42.
MAP from systolic and diastolic pressure, against the 65 mm Hg target.
eye, verbal and motor scores for preverbal children, 3 to 15.
oxygenation ratio with the Berlin ARDS severity ranges.
serum sodium corrected for high glucose, Katz or Hillier factor.
sodium − (chloride + bicarbonate), with the albumin-corrected gap.
urea nitrogen to creatinine ratio, in US or SI units.
estimated creatinine clearance with actual, ideal or adjusted weight.
cardiac output and index from oxygen consumption and saturations.
ANC from the white cell count, neutrophils and bands.
insulin resistance from fasting glucose and insulin, in US or SI units.
FENa from plasma and urine sodium and creatinine: prerenal, indeterminate or tubular pattern.
three-item stroke severity screen for large vessel occlusion, 0 to 4.
water deficit in hypernatremia from sodium, weight and body water.
expected PaCO2 in metabolic acidosis, 1.5 × HCO3 + 8 ± 2.
corrected QT interval by Bazett, Fridericia, Framingham or Hodges.
head CT decision rule for children with minor head trauma.
blood loss before hemoglobin or hematocrit reaches a chosen lowest value.
Devine ideal body weight and adjusted weight from height and sex.
For infants and preverbal children.
For subarachnoid hemorrhage, which uses consciousness in its grades.
Which published the 40-year review of the scale, with its current metrics.