The importance of The Glasgow Coma Scale in determining severity of brain injuries

21st May 2021

The importance of The Glasgow Coma Scale in determining severity of brain injuries

Laura Hopkins, Legal Executive in the Higgs & Sons Personal Injury team, marks Hats for Headway Day by explaining the importance of The Glasgow Coma Scale.

Today people around the country will be donning wacky hats to mark Hats for Headway Day to help raise awareness and funding for people who have suffered brain injury.

I’m sure we’ll see some silly headwear on our own Higgs Zoom calls throughout the day!

Each year around 350,000 people are admitted to hospital with an acquired brain injury. That’s one every 90 seconds.

At Higgs & Sons, we have represented many clients over the last 30 years whose lives have been turned upside down following traumatic brain injury.

Usually the first step for medics is to gauge the severity of an acute brain injury. The Glasgow Coma Scale (GCS) is the most common scoring system to describe the level of consciousness.

There are different levels of coma, ranging from very deep, where the patient shows no response or awareness at all, to shallower levels, where the patient responds to stimulation by movement or opening eyes. The level of coma is usually initially assessed by using the GCS.

It assesses the patient’s ability to open their eyes, move and speak. The total score is calculated by adding up the scores from the different categories, shown in the tables below, and ranges from a minimum of 3 to a maximum of 15.

It is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury.

It is used by trained staff who attend an accident scene such as a road traffic accident and can also be used in A&E and intensive care.

The GCS scores the following:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to sound
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = orientated
  • 4 = confused
  • 3 = words, but not coherent
  • 2 = sounds, but no words
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = obeys command
  • 5 = localising
  • 4 = normal flexion
  • 3 = abnormal flexion
  • 2 = extension
  • 1 = none

The score is documented on a chart.

The degree and duration of a coma are helpful indicators of the severity of a brain injury, and taken in conjunction with the length of time a person is experiencing post-traumatic amnesia, can indicate the likely prognosis for an individual. 

 A brain injury is often classified as follows:

  • Severe: GCS 8 or less
  • Moderate: GCS 9-12
  • Mild: GCS 13-15

Mild brain injuries can result in temporary or permanent neurological symptoms and neuroimaging tests such as CT scan or MRI may or may not show evidence of any damage.

Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills,and/or emotional/behavioural functioning.

The GCS is usually not used with children, where the Paediatric Glasgow Coma Scale (pGCS) is used instead. The pGCS still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together.

The scores are varied as follows:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to voice
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = smiles, oriented to sounds, follows objects, interacts
  • 4 = cries but consolable, inappropriate interactions
  • 3 = inconsistently inconsolable, moaning
  • 2 = inconsolable, agitated
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = moves spontaneously or purposefully
  • 5 = localizing (withdraws from touch)
  • 4 = normal flexion (withdraws to pain)
  • 3 = abnormal flexion (decorticate response)
  • 2 = extension (decerebrate response)
  • 1 = none
  • NT = not testable

When dealing with brain injuries, at Higgs & Sons, we offer a service which goes well beyond obtaining compensation. Our philosophy of building great client relationships and being available whenever you need us, means we can work together to deal with many of the challenges that you face and achieve the best outcome with rehabilitation and compensation. 

Our relationship with you and your family will often continue well beyond settlement of your claim. Read more about our experience in this field here.

Contact me on 01384 327204 or to discuss free of charge how we can help you or a loved one, or, if you prefer, one of our head injury solicitors can come and see you free of charge to discuss making a claim.



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