Level of consciousness is the earliest and most sensitive indicator that a patient is deteriorating — a single point can be the first sign. Score the three Glasgow Coma Scale components separately, read the pupils beside them, trend against the last score, and then screen cognition honestly with Mini-Cog.
Score each component on the patient’s best response
Score the best response obtained, and the best side for motor. If a component cannot be tested — an intubated patient has no testable verbal response, a swollen orbit no testable eye opening — record NT, never a guessed 1.
Pupils
Eye opening
Verbal response
Motor response
Mini-Cog
Register three unrelated words, have the patient draw a clock face with all the numbers and set the hands to a stated time, then ask for the three words. About three minutes, and relatively resistant to education and language effects.
Words recalled (1 point each)
Clock drawing
Orientation ×4 — tick what the patient still has
Ask it conversationally, not as an interrogation: “Just to make sure I have things right — can you tell me your full name, where we are, what month it is, and what brought you in?”
Honest-testing checklist
Correct these before you screen, or the score measures the barrier and not the brain.
GCS
2
Eye
2
Verbal
4
Motor
8
Total
Chart it asE2 V2 M4 = GCS 8
SeveritySevere brain injury
TrendNo previous score entered
Score the patientChoose a value for each component.