"Can you open your eyes for me?"

If a patient opens their eyes when you speak to them, are they automatically a GCS 14?

Not necessarily. Accurate scoring depends on how and why the response occurs

Why This Matters

GCS miscalculations remain common in the field - particularly in Eye Opening and Motor Response scoring.

These errors can impact:

• Clinical decision-making
• Transport priorities
• Accuracy of hospital handover

Key Principles for Accurate Scoring

1. Document the best observed response
   • Score based on the highest level of function demonstrated
2. Identify and communicate trends 
   • Serial GCS assessment are more valuable than a single score
3. Differentiate inability vs. non compliance
   • Is the patient unable to respond, or choosing not to?
4. Baseline matters
   • A patient who is baseline- oriented is a GCS 15, even with pre-existing cognitive impairment 

 The Golden Rule 

A decreasing GCS is an early and critical indicator of patient deterioration.

Factors That Can Interfere with GCS Assessment

1. Pre-Existing Conditions
   • Language barriers
   • Cognitive impairment or developmental delay
   • Hearing or speech impairment
2. Current Interventions
   • Airway management (e.g., intubation, tracheostomy)
   • Medications (e.g., sedation, analgesia)
3. Acute Illness or Injury
   • Facial, orbital, or cranial trauma
   • Stroke symptoms (e.g., dysphasia, hemiplegia)
   • Spinal cord injury
   • Hypoxia

Approach to GCS Assessment 

CHECK

Identify factors that may interfere with accuracy

OBSERVE

Look for spontaneous eye opening, speech, and movement

STIMULATE

Progress from verbal → tactile → painful stimuli (only as required)

RATE

Assign GCS based on the best observed response

 Additional Resource

For further detail, refer to: Glasgow Coma Scale Foundation
glasgowcomascale.org