In patients with acute brain injury and neurological disorders, the assessment of consciousness is of paramount importance to stratify the possible outcome and define the clinical management strategy [1], [2]. The Glasgow Coma Scale (GCS), developed by Graham Teasdale and Bryan Jennett in the 1970 s, is a widely used tool in healthcare settings to evaluate the neurological status of patients, especially in the acute phase following traumatic brain injury [3]. The GCS, including eye-opening (E-GCS), motor (M-GCS), and verbal (V-GCS) responses, provides a structured framework for quantifying the level of consciousness in patients with brain injury [3], [4] (see Table 1 for a detailed description).

Particularly, disorders of consciousness (DoC), such as coma, vegetative state, and minimally conscious state, can be characterized by impaired verbal function [5], [6], [7]. Severity varies, with coma patients lacking overt verbal responses, while those in vegetative or minimally conscious states may exhibit inconsistent or limited verbal expression [5], [6], [7].

It is worth emphasizing that the accurate assessment of the V-GCS can pose challenges and is the most inconsistent among the three variables included in the GCS scale [8], [9], [10]. In particular, in intubated patients, the ability to communicate is compromised, and the verbal component is referred to as "T," recognizing the inherent limitations of this assessment [4]. Moreover, the accuracy of V-GCS scoring may also be affected by the difficulty of discriminating between subcomponents of the verbal response [9], [11]. Notably, the study by Namiki et al. [11] reported that the most significant scoring errors made by inexperienced medical personnel in a large number of patients with head injury occurred in the V4 component. In addition, Brennan et al. [9] pointed out a degree of uncertainty in clinical assessments regarding the distinction between V2, V3, and V4 scores in patients with moderate trauma [9].

Given the inconsistency in the assessment of the verbal component of GCS, which could affect the prediction of outcome and survival, it could be helpful to define principles for clinical evaluation of this variable.

The aim of this brief report is to describe the pathophysiological relationship between DoC and verbal function and to provide insights to improve the accuracy and reliability of V-GCS scoring. Possible strategies to implement in the routine clinical practice the provided tips are discussed.