From the Guidelines
Mental status per 3 is a crucial assessment of a patient's cognitive function, indicating they are aware of their person, place, and time, which is essential for evaluating baseline mental status and monitoring neurological changes. This assessment is vital in healthcare settings, particularly in patients with traumatic brain injuries, as it helps determine decision-making capacity and identify potential neurological deterioration. According to 1, the Glasgow Coma Scale (GCS) is a standardized clinical scale used to assess neurologic function, but a single GCS score has limited prognostic value in mild traumatic brain injury (TBI). However, serial GCS scores are valuable in patients with mild TBI, as they can predict outcomes and detect patients who require neurosurgical procedures.
When assessing mental status per 3, healthcare providers typically ask simple questions to evaluate a patient's orientation, such as "What is your name?", "Where are you right now?", and "What is today's date?" 1. A change from baseline orientation status can indicate neurological deterioration, medication effects, or progression of conditions affecting cognition. In patients with mild TBI, it is essential to use serial GCS scores to monitor changes in neurological function, as a single GCS score may not accurately reflect the degree of parenchymal injury after trauma.
Key points to consider when assessing mental status per 3 include:
- The importance of serial assessments in patients with mild TBI
- The limited prognostic value of a single GCS score in mild TBI
- The need to monitor changes in neurological function to identify potential deterioration
- The use of simple questions to evaluate a patient's orientation and cognitive function
- The importance of considering the patient's baseline mental status and decision-making capacity when assessing mental status per 3.
In clinical practice, healthcare providers should prioritize serial assessments of mental status per 3, particularly in patients with mild TBI, to ensure timely identification of potential neurological deterioration and provide appropriate interventions. This approach is supported by the most recent and highest-quality study available, which emphasizes the importance of serial GCS scores in patients with mild TBI 1.
From the Research
Mental Status Assessment
The mental status of a patient can be assessed using the Glasgow Coma Scale (GCS), a tool that has been widely used for over 40 years 2, 3. The GCS is used to identify and chart possible changes or deterioration in a patient's level of consciousness and their neurological status.
Glasgow Coma Scale
The GCS is a reliable and widely used assessment tool that allows clinicians to monitor patients' conditions, identify deterioration, and make clinical decisions 3. The scale assesses three aspects of a patient's behavior: eye opening, verbal response, and motor response. The GCS has been shown to be effective in assessing the level of consciousness in patients with neurological conditions, including traumatic brain injury 4, 5.
Pediatric Glasgow Coma Scale
The Pediatric Glasgow Coma Scale is a modified version of the GCS that is used to assess the mental status and level of consciousness in preverbal children aged ≤ 2 years 6. This scale allows clinicians to obtain, track, and communicate the mental status of young children who are unable to respond verbally.
Intubation Thresholds
Recent studies have examined the relationship between GCS scores and intubation thresholds in patients with traumatic brain injury 4, 5. These studies suggest that intubation at a GCS threshold of ≤5 may confer an additional benefit in disposition without worsened outcomes, while intubation at higher GCS thresholds may be associated with higher mortality rates and longer hospital stays. Key findings include:
- Intubation within an hour of arrival with a GCS score ≤8 after major trauma was not associated with differences in-hospital mortality 4
- A GCS ≤5 was the threshold at which intubation in TBI patients conferred an additional benefit in disposition without worsened outcomes of mortality, H-LOS, or ICU-LOS 5
- Intubated patients at GCS thresholds ≤8 and ≤10 had significantly higher mortality rates than non-intubated patients 5