II. Indications
III. Scoring
- Eye Opening
- Spontaneous: 4
- To speech: 3
- To pain or pressure: 2
- No Response: 1
- Best Verbal Response
- Oriented (Infant coos or babbles): 5
- Confused (Infant irritable cries): 4
- Inappropriate words (Infant Cries to pain): 3
- Incomprehensible sounds (Infant Moans to pain): 2
- No Response: 1
- Best Motor Response
- Obeys (Infant moves spontaneous/purposefully): 6
- Localizes (infant withdraws to touch): 5
- Withdraws to pain: 4
- Abnormal Flexion (Decorticate Posturing): 3
- Abnormal Extension (Decerebrate Posturing): 2
- No Response: 1
IV. Interpretation
- Total: 3-15
- Mild Head Injury: 13-15 (at two hours post-injury)
- Moderate Head Injury: 9-12 (at two hours post-injury)
-
Severe Head Injury (Coma): <= 8 (at two hours post-injury)
- Confers Significant Mortality Risk
- Modifiers
- 2T-8
- 2T refers to the verbal score uninterpretable due to Endotracheal Intubation
- Only motor (1-6) and eye opening (1-4) are calculated (maximum 2T-10)
- In this case (2T-8), refers to cut-off for Severe Traumatic Brain Injury
- Not-Tested (NT)
- Use NT to mark items that could not be tested (e.g. intubated patient)
- Example: E-1, V-NT, M-3
- 2T-8
V. Precautions
- In Head Injury, document exactly what is seen (in addition to the score)
- Describe what painful did in response to painful stimuli (e.g. sternal rub, trapezius squeeze)
VI. References
- Swaminathan and Petrosoniak (2026) Neuro Exam in TBI, EM:Rap, 8/10/2026
- Swaminathan and Hicks in Herbert (2020) EM:Rap 20(1):6-7
- Morray (1984) Crit Care Med 12: 1018 [PubMed]
- Teasdale (1974) Lancet 2:81-4 [PubMed]
- Davis (1987) in Rogers, Textbook of Ped Int Care