GCS: normal max score: E4V5M6 = 15.  Minial score (coma): E1V1M1=3.

• • EYE OPENING 

    • Spontaneous: 4. Eyes opening spontaneously with blinking at baseline. 

    • To speech: 3.  To verbal stimuli, command. 

    • To pain: 2. Pain from sternum/trapezius squeeze/nail-bed pressure.  Not applied to face. 

    • None: 1  

• VERBAL RESPONSE 

  • Oriented: 5. Converses and oriented

  • Confused: 4. Converses but confused, disoriented but able to answer questions when directred. 

  • Inappropriate words: 3. Intelligible, no sustained sentences 

  • Incomprehensible sounds: 2. Moans/groans, no speech 

  • None: 1. No verbalization of any type 

• MOTOR RESPONSE 

  • • Obeys commands. 6 .  Obeys commands for movement. 

    • Localizes pain: 5. Arm attempts to remove supra-orbital/chest pressure.  Purposeful movement to painful stimulus. 

    • Withdraws from pain: 4. Arm withdraws to pain, shoulder abducts 

    • Abnormal flexion to pain: 3. Withdrawal response or assumption of hemiplegic posture.  Decorticate posturing. 

    • Abnormal extension to pain: 2. Shoulder adducted and shoulder and forearm internally rotated,  Decerebrate posturing. 

    • None: 1. No response to painful stimuli

GCS <8 = coma

A GCS score of 13 or higher indicates mild brain injury, 9 to 12 moderate brain injury, and 8 or less severe brain injury.

Full Outline of UnResponsiveness (FOUR score):   Minimum score: 0, E0 M0 B0 R0.   Maximum score: 16, E4 M4 B4 R4 

• E4: eyelids open or opened, tracking, or blinking to command 

• E3: eyelids open but not tracking 

• E2: eyelids closed but open to loud voice 

• E1: eyelids closed but open to pain 

• E0: eyelids remain closed with pain 

• M4: thumbs-up, fist, or peace sign 

• M3: localizing to pain 

• M2: flexion response to pain 

• M1: extension response to pain 

• M0: no response to pain or generalized myoclonus status 

• B4: pupil and corneal reflexes present 

• B3: one pupil wide and fixed 

• B2: pupil or corneal reflexes absent 

• B1: pupil and corneal reflexes absent 

• B0: absent pupil, corneal, and cough reflex

• R4: not intubated, regular breathing pattern 

• R3: not intubated, Cheyne-Stokes breathing pattern 

• R2: not intubated, irregular breathing 

• R1: breathes above ventilatory rate 

• R0: breathes at ventilator rate or apnea