Expansion
Eyes out of 4, Verbal out of 5, Motor out of 6
Expansion
Eye opening (4): 4 spontaneous, 3 to voice, 2 to pain, 1 none
Verbal response (5): 5 orientated, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none
Motor response (6): 6 obeys commands, 5 localises to pain, 4 withdraws from pain, 3 abnormal flexion (decorticate), 2 extension (decerebrate), 1 none
Minimum score is 3, not 0. Maximum is 15.
Reporting: always give the breakdown (E, V, M) rather than the total alone, since the components carry different information and the motor score is the best single predictor of outcome.
Severity: mild 13 to 15, moderate 9 to 12, severe 8 or less.
Practical points
- If the patient is intubated, the verbal score is recorded as 1T and the maximum becomes 11T
- Localising means moving the hand above the clavicle towards a central painful stimulus; withdrawal is a non-purposeful pull away
- Apply a central stimulus (trapezius squeeze or supraorbital pressure) for the best response, and peripheral for localisation
- AVPU is the rapid alternative, where P roughly corresponds to a GCS of 8