What is the Glasgow Coma Scale (GCS) score of an intoxicated patient who opens eyes to verbal stimuli, is disoriented but has an organized verbal response, and obeys verbal commands?

Glasgow Coma Scale Score for an Intoxicated Patient

The patient's Glasgow Coma Scale (GCS) score is 13 out of 15, calculated as: Eye opening to verbal stimuli (3 points) + Confused verbal response (4 points) + Obeys commands (6 points).

GCS Component Breakdown

The Glasgow Coma Scale consists of three components that are scored independently and then summed to give a total score between 3 and 15:

1. Eye Opening (E):

   • Opens eyes to verbal stimuli = 3 points
   • (Scale: 4=spontaneous, 3=to verbal stimuli, 2=to pain, 1=no response)

2. Verbal Response (V):

   • Disoriented but talks in an organized fashion = 4 points
   • (Scale: 5=oriented, 4=confused/disoriented, 3=inappropriate words, 2=incomprehensible sounds, 1=no response)

3. Motor Response (M):

   • Obeys verbal commands = 6 points
   • (Scale: 6=obeys commands, 5=localizes pain, 4=withdraws to pain, 3=abnormal flexion, 2=extension, 1=no response)

Clinical Interpretation

This GCS score of 13 falls into the category of mild traumatic brain injury (GCS 13-15) according to standard classification 1. The patient's intoxication is likely affecting their level of consciousness, particularly the verbal and eye opening components, while motor function remains intact.

Important Considerations in Intoxicated Patients

• The GCS assessment may be confounded by alcohol or drug intoxication, which can independently depress consciousness 2.
• Serial assessments are more valuable than a single determination to monitor for improvement or deterioration 1.
• While the patient's current score indicates mild impairment, continued monitoring is essential as intoxicated patients may deteriorate or improve as the effects of substances wear off.

Clinical Application

• A GCS of 13 indicates the need for close monitoring but does not necessarily require immediate neurosurgical intervention 1.
• The patient's ability to obey commands (M=6) is a positive prognostic sign, even with the reduced eye and verbal scores.
• Documentation should note that the assessment was performed while the patient was intoxicated, as this may affect clinical decision-making and interpretation of the score.

Common Pitfalls to Avoid

1. Failing to assess all three components separately before calculating the total score.
2. Misinterpreting disorientation due to intoxication as a more severe verbal response impairment.
3. Not performing serial assessments to track changes as intoxication resolves.
4. Relying solely on the total score without considering the individual components, which provide more detailed neurological information 2.

The GCS remains the most universally utilized level of consciousness scale worldwide despite its limitations in certain populations such as intoxicated patients 3. When used correctly with awareness of potential confounding factors, it provides valuable information for clinical assessment and decision-making.