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The Glasgow Coma Scale
A head-injured patient speaks inappropriate words, does not open his eyes even to painful stimulus, and withdraws his limb from pain. What is his Glasgow Coma Scale score?
- correctA. 8
- B. 7
- C. 10
- D. 9
Explanation
Key fact
Eyes out of 4, voice out of 5, movement out of 6. Score each separately, then add.
8. Eyes 1, verbal 3, motor 4.
Why
Eyes do not open even to pain, which is E1.
Inappropriate words - recognisable but not conversational - is V3.
Withdrawal from pain, without localising, is M4.
One plus three plus four is 8.
A score of 8 or less is the conventional threshold for intubation.
Scoring the Glasgow Coma Scale
Why not the others
- B. 7 — would follow if the motor response were abnormal flexion, scoring 3 instead of 4.
- C. 10 — would require two components to be scored one point higher than they are.
- D. 9 — would follow if the eyes opened to pain, scoring 2 instead of 1.
Remember
Four, five, six - eyes, voice, movement. Minimum three, maximum fifteen.
Go deeper
The lowest possible score is 3, not 0, because every component scores at least 1.
Localising to pain means the hand crosses the midline towards the stimulus; withdrawal is a reflex pull away, and the distinction is a whole point.
The motor score carries the most prognostic weight, which is why it is recorded separately as well as in the total.
Bailey & Love's Short Practice of Surgery, 28th ed. (CRC Press, 2023); Harrison's Principles of Internal Medicine, 22nd ed. (McGraw Hill, 2025).