Three minimalist mnemonics for remembering the Glasgow Coma Scale

Best eye response: “Discomfort and Direction“: Patient opens eyes to to pain (+2) or verbal command (+3).

Best verbal response: “Noises, Nonsense, Not correct“: Patient produces incomprehensible sounds (+2), inappropriate words (+3) or confused responses (+4).

Best motor response: “Extend, then Bend, Escape, Locate“: Patient extends to pain (+2), flexes to pain (+3), withdraws from pain (+4) or localizes pain (+5).

We’ll assume that you don’t need help remembering minimum (+1) or maximum (+4, +5, or +6) sub-scores.

Background

Per MDCalc.com, the Glasgow Coma Scale is “designed for use in serial assessments of patients with coma from either medical or surgical causes. In the care of an individual patient, the ratings of the three criteria in the Glasgow Coma Scale (best eye response, best voice response and best motor response) should be assessed, monitored, reported, and communicated separately [ie, independently as eye-verbal-motor].” The authors compare the Glasgow Coma Scale (sub-scores of component criteria, applicable if any of three components is not testable) versus Score (total score, only applicable when all three components are testable).

Reasoning

Order the component criteria inferiorly, starting from the top of the head: eyes first, then mouth (ie, verbal response), then upper limbs (ie, motor response). This order corresponds with the conventional order of increasing maximum sub-scores of 4, 5 and 6 points. Likewise, these mnemonics starts each scale component at the lowest score (all +1) and continues to the maximum point number (+4, +5 or +6).

Where these mnemonics differs from others is that it assumes that you already know that a +1 eye response represents absence of eye opening, a +1 verbal response represents absence of verbal response and that a +1 motor response represents absence of motor response. Likewise, let’s assume you’ll have no trouble intuiting that a maximum (+4) eye response represents spontaneously open eyes, a maximum (+5) verbal response represents orientation (ie, to person, place, and location) and that a maximum (+6) motor response represents following commands. The key here is remembering that the Glasgow Coma Scale is primarily focused on categorizing the patient’s responses.

Shoutout to Mike Wong from Sketchy Medicine for the neat way of remembering decerebrate and decorticate posturing as “extending” and “bending”.

Recap

The three component criteria are:

1. Best eye response (4 total points)

Local injury, edema, or otherwise unable to be assessed, mark “Not testable (NT)

No eye opening (+1)

To pain (+2)

To verbal command (+3)

Spontaneously (+4)

2. Best verbal response (5 total points)

If intubated or otherwise unable to be assessed, mark “Not testable (NT)

No verbal response (+1)

Incomprehensible sounds (+2)

Inappropriate words (+3)

Confused (+4)

Oriented (+5)

3. Best motor response (6 total points)

If on sedation/paralysis or unable to be assessed, mark “Not testable (NT)

No motor response (+1)

Extension to pain (+2)

Flexion to pain (+3)

Withdrawal from pain (+4)

Localizes pain (+5)

Obeys commands (+6)

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