Bedside neurological assessment with adult and pediatric scoring, severity bands and intubation guidance. Calculations run locally in your browser.
Disclaimer: This calculator is a clinical decision aid, not a substitute for bedside judgment. Score every component before sedation or paralysis where possible, document the breakdown (e.g. E3V4M5 = 12), and reassess serially. Pupil reactivity and focal deficits are not part of GCS but should be documented alongside it. Use the pediatric scale for children under 5 years and preverbal infants.
The FOUR (Full Outline of UnResponsiveness) score replaces verbal response with brainstem reflexes and respiratory pattern, so it is usable in intubated and sedated ICU patients where verbal scoring is not possible. GCS remains the standard for ED triage, trauma documentation and prehospital handover; FOUR is a complement, not a replacement.
Use the pediatric modification (verbal and motor descriptors adapted by James 1986 / Reilly et al.) for children under 5 years and any preverbal child. Above 5 years and developmentally typical, the standard adult scale applies.
A GCS of 8 or below is the conventional indication to consider definitive airway protection ("GCS ≤8, intubate"), but the decision is clinical: trajectory, gag reflex, vomiting, expected transport time and aspiration risk all weigh in. A falling GCS by 2 points or more also warrants reassessment of airway.
Acute alcohol intoxication can lower GCS independently of brain injury, but you should never attribute a low GCS to alcohol alone in a trauma patient. Image the head, treat as TBI until proven otherwise, and reassess as the alcohol clears.
Compatible with current Indian ED workflows and NABH documentation requirements. Always record the breakdown (E_V_M_) alongside the total.
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