From the Guidelines
The correct answer is (c) 8. The Glasgow Coma Scale (GCS) assesses three components: eye opening, verbal response, and motor response. In this case, the patient opens eyes to pain (2 points), makes incomprehensible sounds (2 points), and withdraws to pain (4 points). Adding these scores together (2+2+4) gives a total GCS score of 8, as recommended by the assessment of traumatic brain injury using the Glasgow coma scale 1. This indicates a severe brain injury, as GCS scores between 9-12 represent moderate injuries, while scores of 8 or below indicate severe brain injury. The GCS is an important clinical tool for objectively assessing consciousness level and neurological function in patients with head injuries, and a score of 8 would typically warrant close monitoring and possible neurosurgical intervention depending on other clinical findings and imaging results. Key points to consider in this patient's assessment include:
- The patient's eye opening response to pain, which corresponds to 2 points on the GCS
- The patient's verbal response of making incomprehensible sounds, which corresponds to 2 points on the GCS
- The patient's motor response of withdrawing to pain, which corresponds to 4 points on the GCS
- The importance of regularly reassessing the patient's neurological status to detect any potential secondary neurological deterioration, as emphasized in the management of severe traumatic brain injury 1.
From the Research
Glasgow Coma Scale Score Calculation
To determine the Glasgow Coma Scale (GCS) score of a patient, we need to assess three components:
- Eye opening
- Verbal response
- Motor response
Components of GCS Score
- Eye opening:
- Spontaneous: 4
- To verbal command: 3
- To pain: 2
- None: 1
- Verbal response:
- Oriented: 5
- Confused: 4
- Inappropriate words: 3
- Incomprehensible sounds: 2
- None: 1
- Motor response:
- Obeys commands: 6
- Localizes pain: 5
- Withdraws to pain: 4
- Flexion to pain: 3
- Extension to pain: 2
- None: 1
Calculation of GCS Score
Based on the information provided, the patient:
- Opens his eyes to pain: 2
- Makes incomprehensible sounds: 2
- Withdraws his arm to pain: 4 The total GCS score is: 2 + 2 + 4 = 8
Relevant Studies
Studies have shown that the GCS score is a useful tool in assessing the severity of head injury 2, 3, 4, 5. However, it has its limitations, and other factors such as hypoxia and CT scan features should also be considered when predicting outcomes 4. The GCS score has been shown to have a nonlinear relationship with mortality and functional outcome 3.
GCS Score and Outcome
A GCS score of 8 or less is often associated with severe brain injury, but this definition has been questioned as outdated 2. The study by 4 found that GCS scores alone had limited predictive value, but the presence of hypoxia and certain CT scan features increased the probability of a poor outcome.
Answer
Based on the calculation, the correct answer is: (c) 8