What is the Glasgow Coma Scale (GCS) score of a patient with a head injury who opens their eyes to pain, withdraws their arm to pain, and makes incomprehensible sounds?

From the Guidelines

The Glasgow Coma Scale score for this patient is 8, as the patient opens eyes to pain, makes incomprehensible sounds, and withdraws to pain, which corresponds to a total score of 8 (2+2+4) according to the original description of the Glasgow Coma Scale 1. The GCS assesses three components: eye opening, verbal response, and motor response.

• Eye opening is scored from 1 to 4, with 1 being no response and 4 being spontaneous opening.
• Verbal response is scored from 1 to 5, with 1 being no response and 5 being oriented and converses normally.
• Motor response is scored from 1 to 6, with 1 being no response and 6 being obeys commands. 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 of 8. This score is significant because a GCS of 8 or less defines coma and indicates a severe head injury requiring immediate medical attention, likely including airway management and neurosurgical evaluation, as recommended in the management of severe traumatic brain injury 1. The patient's inability to open eyes spontaneously, communicate coherently, or follow commands reflects significant neurological impairment affecting consciousness and brain function. The motor component of the GCS remains robust in sedated patients and is well correlated with the severity of head trauma 1. Therefore, the GCS score of 8 is a critical indicator of the patient's neurological status and guides further management.

From the Research

Glasgow Coma Scale Score Calculation

The Glasgow Coma Scale (GCS) is a neurological scale intended to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. The patient's GCS score is calculated based on three aspects:

• Eye opening
• Verbal response
• Motor response

Calculation of GCS Score for the Given Patient

Given that the patient opens his eyes and withdraws his arm to pain, and makes incomprehensible sounds, we can calculate the GCS score as follows:

• Eye opening: The patient opens his eyes, which corresponds to a score of 2 (opens eyes to pain) or possibly 3 (opens eyes to voice), but based on the information provided, it is more likely 2.
• Verbal response: The patient makes incomprehensible sounds, which corresponds to a score of 2 (incomprehensible sounds).
• Motor response: The patient withdraws his arm to pain, which corresponds to a score of 4 (withdraws to pain).

Total GCS Score

Based on the above, the total GCS score would be: 2 (eye opening) + 2 (verbal response) + 4 (motor response) = 8.

Comparison with Study Findings

Studies such as 2, 3, 4, 5, and 6 discuss various aspects of traumatic brain injury treatment and patient assessment, including the use of the Glasgow Coma Scale. However, these studies do not directly address the calculation of the GCS score for a patient with the specified symptoms.

• The study 2 discusses the use of hypertonic saline and mannitol in reducing intracranial pressure after severe traumatic brain injury.
• The study 3 reports on the use of transcranial direct current stimulation in patients with severe traumatic brain injury.
• The study 4 provides a systematic review of hypertonic saline treatment in traumatic brain injury.
• The study 5 compares the effects of two different doses of 3% hypertonic saline with mannitol during decompressive craniectomy following traumatic brain injury.
• The study 6 compares intracranial pressure measurements before and after hypertonic saline or mannitol treatment in children with severe traumatic brain injury.

Key Points

• The patient's symptoms suggest a GCS score of 8.
• The GCS score is a crucial assessment tool in traumatic brain injury.
• Various studies discuss different aspects of traumatic brain injury treatment, but the calculation of the GCS score is based on the patient's specific symptoms and responses.

Some key points to consider:

• The GCS score is used to assess the level of consciousness in a patient.
• A lower GCS score indicates a more severe brain injury.
• The GCS score is calculated based on eye opening, verbal response, and motor response.
• The patient's GCS score of 8 suggests a severe brain injury.