Glasgow Coma Scale

Best eye opening

Mnemonic: ESPN

• 4 – Eye(s) open spontaneously
• 3 – to Sounds
• 2 – to Pain
• 1 – No opening

Best verbal response

Mnemonic: ASWGN

• 5 – Appropriate
• 4 – Sentences (confused)
• 3 – Words (inappropriate)
• 2 – Groans and grunts (incomprehensible)
• 1 – No sound

Best motor response

Mnemonic: OLD BEN

• 6 – Obeys
• 5 – Localizes pain
• 4 – Draws away from pain (withdrawal)
• 3 – Bends to pain, i.e., decorticate
• 2 – Extends to pain, i.e., decerebrate (extends elbow to nailbed pressure)
• 1 – No response

Important points

1. Minimum score = 3
2. Maximum score = 15 or 11T (if intubated)
3. Record best response in each category and sum of all 3. e.g., E3 V3 M4 (10)
4. “1T” is designated in verbal response for intubated patients. e.g., E3 V1T M4 (8T)
5. GCS ≤ 8 = Coma
6. GCS < 8 = Intubate (If less than eight, intubate)
7. Head injury classification:
   • Mild: GCS 13-15
   • Moderate: GCS 9-12
   • Severe: GCS 3-8
8. ICP monitoring indications:
   • GCS ≤ 8 after resuscitation + abnormal head CT scan
   • GCS ≤ 8 + normal head CT scan + ≥2 risk factors for intracranial hypertension (including age >40 years, SBP < 90 mmHg, and motor posturing)
9. CT head indications:
   • GCS <15 at 2 hours following injury
   • GCS <13 at any stage

Question and Example

A 20 year old man is hit over the head with a mallet. On arrival in the accident and emergency department he opens his eyes to pain and groans or grunts. On application of a painful stimulus to his hands, he extends his arm at the elbow. What is his Glasgow coma score?

• E = Pain (2)
• V = Groans/grunts (2)
• M = Extends to pain (2)

So, his GCS is E2 V2 M2 (6).