Adult GCS Assessment

The adult Glasgow Coma Scale (GCS) assessment is the basis of each clinicians basic assessment of a patient’s neurological response. It has been well recognised as the most reliant indicator of a person’s outcome post traumatic brain injury and is helpful in assessing a person’s basic overall neurolgical assessment.

The benefits of the Glasgow Coma Scale in pre-hospital care and assessment of patients is still in debate, but widely used.

How to Perform an Adult GCS Assessment

The following identifies the steps in assessing an adult’s GCS:

Best eye response (E)

There are 4 grades starting with the most severe:

 1.No eye opening

 2.Eye opening in response to pain.

 3.Eye opening to speech.

 4.Eyes opening spontaneously

Best verbal response (V)

There are 5 grades starting with the most severe:

 1.No verbal response

 2.Incomprehensible sounds. (Moaning but no words.)

 3.Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)

 4.Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)

 5.Oriented. (Patient responds coherently and appropriately to questions relating to time and place).

 Best motor response (M)

 There are 6 grades starting with the most severe:

 1.No motor response

 2.Extension to pain (abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)

 3.Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)

 4.Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)

 5.Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)

 6.Obeys commands. (The patient does simple things as asked).