The Glasgow Coma Scale rates three responses: eye opening, verbal response, and best motor response. Their sum, from 3 to 15, describes a patient’s level of consciousness and how it changes over time. Rate each response to score it, see what the total means after a head injury, and record the result with the free template.
GCS result template
FreeGLASGOW COMA SCALE RESULT Date and time: [Date, time] Patient: [Name or ID, age] Assessed by: [Name, role] Reason: [Head injury, reduced consciousness, sedation hold, or routine neuro observations] Interfering factors: [Breathing tube, sedation or paralysis, eye swelling, hearing loss, language, spinal cord injury, or none] COMPONENTS Eye opening, E: [1 to 4 or NT; the response seen, such as opens to sound] Verbal response, V: [1 to 5, NT, or VT if intubated; the response seen, such as confused] Best motor response, M: [1 to 6 or NT; the response seen and the arm, such as localising with the right arm] Stimulus used: [Spoken or shouted request, finger tip pressure, trapezius pinch, or supraorbital pressure] NT reasons: [Each component not tested and why, or none] SCORE Total: [E, V, M and the sum from 3 to 15; no total if any component is NT] Severity: [Mild, moderate, or severe, for head injury] Pupils: [Size in mm and reaction to light, left and right] GCS-P: [Total minus 1 for one unreactive pupil or 2 for both, if used] Limb movement: [Weakness or difference between sides, by limb] TREND Previous assessments: [Times and scores, with components] Change: [Better, stable, or worse; which component changed and by how much] ACTIONS Escalation: [Who was told and when, or none needed] Investigations: [CT head, glucose, others] Next assessment: [Interval, such as every 30 minutes until back to 15] Clinician: [Name, credentials]
Every item as published. The total and what it means update with each answer; nothing you choose leaves this page.
Check for factors interfering with communication, ability to respond and other injuries. Observe eye opening, content of speech and movements of right and left sides. Stimulate with sound, a spoken or shouted request, then with physical pressure on the finger tip, trapezius or supraorbital notch. Rate each component according to the highest response observed.
Use it for
Before rating, look for anything that stops a response from showing: a breathing tube, sedation, paralysis, swelling around the eyes, deafness, language, or a spinal cord injury.
Avoid: Rating a response that couldn’t be tested as 1. Record NT and the reason.
Watch first for what the patient does unprompted, then speak, then apply pressure only if there’s still no response.
Avoid: A sternal rub. It bruises, and the response is hard to read; the official guidance strongly discourages it.
Rate each component by the best response seen, against the defined criteria.
Avoid: Taking a grasp reflex as obeying commands. Ask the patient to let go as well as squeeze, or to stick out their tongue.
Normal flexion is a quick bend at the elbow, the arm moving away from the body. Abnormal flexion is slow and stereotyped.
Write all three components with the total, and chart each assessment so a change is easy to see.
Avoid: Handing over the total alone. The next clinician can’t tell which response has changed.
When a component can’t be tested, record NT and the reason, and follow the components that can be tested.
Avoid: Counting NT as 1. It lowers the total, makes the patient look sicker, and confuses the team.
Each one follows the recording template. Use them to judge how much to write.
Emergency department, 78-year-old woman on apixaban, fall at home about 2 hours earlier
Eye opening E3: eyes closed until spoken to, then open. Verbal V4: talks in full sentences and knows her name, but thinks it’s morning and that she’s at home. Best motor M6: squeezes and lets go on request with both hands. Stimulus: spoken request; no pressure needed. NT: none; hearing aids in, English her first language.
E3 V4 M6 = 13, mild head injury. Pupils 3 mm, equal and reactive. No weakness in any limb.
Paramedics recorded E4 V5 M6 = 15 at the scene and E4 V4 M6 = 14 on arrival at 09:10. 09:40: E3 V4 M6 = 13. 10:10: 13, unchanged. Down 2 points since the scene, and the drop has lasted over 30 minutes.
Emergency physician told at 09:42 and reviewed at once. Urgent CT head: 7 mm acute right subdural hematoma, no midline shift. Apixaban held and reversed per protocol; neurosurgery consulted and advised admission. GCS and pupils every 30 minutes; repeat CT for any further fall, especially in the motor response.
Intensive care unit, 34-year-old man, day 3 after a severe traumatic brain injury, sedation paused for the assessment
Eye opening E2: no opening to a shouted request; opens to finger tip pressure. Verbal VT: endotracheal tube in place. Best motor M5: right hand reaches up past the collarbone to supraorbital pressure; left arm bends quickly at the elbow, normal flexion. Stimulus: shouted request, finger tip pressure, then supraorbital pressure. NT: verbal, intubated.
Recorded as E2 VT M5. No total: the verbal response can’t be tested. Pupils 4 mm, equal and reactive. Left arm weaker than the right.
At the scene, before intubation: E1 V2 M4 = 7. Days 1 and 2: E1 VT M4. Today: E2 VT M5, up 1 in eye opening and 1 in motor, the same on two checks an hour apart.
Improvement reported to the intensivist on rounds. No repeat CT needed for an improving exam. Daily sedation pause for assessment continues, with GCS and pupils hourly; weaning toward extubation discussed with the team.
A total of 8 can be E2 V2 M4 or E1 V1 M6. Write the three components every time.
A patient with a breathing tube hasn’t got “no verbal response”. Record VT or NT, and give no total.
A drop in the motor response matters most. Compare each assessment with the last one, and escalate a drop at once.
It bruises and gives responses that are hard to read. Use finger tip pressure, then the trapezius or the supraorbital notch.
A hand that grips can be a reflex. Ask for a second step, such as letting go, before scoring 6.
Vero Scribe records the GCS in your template from the visit, with the patient’s consent, or from your dictation: each component, the stimulus, any NT reasons, the pupils, the trend, and what you did. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Rate eye opening from 1 to 4, verbal response from 1 to 5, and best motor response from 1 to 6, each by the best response seen. Add the three for a total from 3 to 15, and write it with the components, such as E3 V4 M6 = 13.
A GCS of 15 is fully alert and orientated; 3 is no response at all. After a head injury, 13 to 15 is mild, 9 to 12 moderate, and 3 to 8 severe. A total of 8 or less is the usual definition of coma, and the point where airway protection is considered.
Rate eye opening and motor response as usual, and record the verbal response as not testable: VT or NT. The Glasgow guidance is to give no total then, since counting the verbal as 1 makes the patient look sicker. Some units write a total with a T, such as 8T; if yours does, keep the components beside it.
The wording was updated to describe the stimulus actually used. In the same update, “inappropriate words” and “incomprehensible sounds” became “words” and “sounds”. The scores didn’t change, and the six-point motor scale, with normal and abnormal flexion, is now recommended for all purposes.
The GCS-Pupils score combines the GCS total with pupil reaction. Subtract 1 when one pupil doesn’t react to light, 2 when neither does, and nothing when both react. It runs from 1 to 15 and adds information about outcome, mostly in severe injury.
Yes. Children over 5 are rated on the adult scale. Younger children can’t be orientated or follow commands, so pediatric versions fit the verbal and motor responses to what a child can do at that age. On the Adelaide version described on the official site, a normal total is lower in infants. Name the version you used in the record.
AVPU, for alert, voice, pain, unresponsive, is a quicker check used in triage; responding only to pain roughly matches a GCS of about 8. The FOUR score rates eyes, motor response, brainstem reflexes, and breathing from 0 to 16, and needs no verbal score, so it suits intubated patients.
Any trained clinician. Nurses, doctors, and paramedics all use it, and studies show nurses and doctors rate it equally well. Training in the structured approach on the official site makes ratings more consistent.
Yes. It’s free for clinical care and research with no licence needed, with the University of Glasgow’s copyright acknowledged. The official assessment aid is on the Glasgow Coma Scale site, and the recording template on this page is free to copy or download too.
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Notes drafted from the bedside, reviewed by you.
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Every tool, by area, with what its scores mean.
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