What is the Glasgow Coma Scale (GCS) score of a patient with eye opening to pain, disoriented verbal response, and localizing motor response to pain?

Glasgow Coma Scale Score Calculation for the Patient

The patient's Glasgow Coma Scale score is 11 based on the assessment of eye opening to pain (2 points), confused verbal response (4 points), and localizing motor response to pain (5 points).

Breakdown of GCS Scoring

The Glasgow Coma Scale (GCS) consists of three components that must be assessed separately before calculating the total score 1:

1. Eye Opening (E):

   • Patient opens eyes to painful stimulus (sternal rub) = 2 points
   • (Scale: 4=spontaneous, 3=to voice, 2=to pain, 1=none)

2. Verbal Response (V):

   • Patient is disoriented, saying "Leave me alone! I'm watching TV!" = 4 points
   • (Scale: 5=oriented, 4=confused, 3=inappropriate words, 2=incomprehensible sounds, 1=none)

3. Motor Response (M):

   • Patient localizes pain by attempting to push your hand away = 5 points
   • (Scale: 6=obeys commands, 5=localizes pain, 4=withdraws from pain, 3=flexion to pain, 2=extension to pain, 1=none)

Total GCS Score = E(2) + V(4) + M(5) = 11

Clinical Interpretation

A GCS score of 11 classifies this patient as having moderate traumatic brain injury (GCS 9-12) 1. This classification has important clinical implications:

• Patients with moderate TBI have a higher risk of intracranial lesions requiring neurosurgical intervention compared to those with mild TBI 1
• Serial GCS assessments are crucial for detecting neurological deterioration, and a decrease of 2 or more points should prompt immediate reevaluation 1

Important Considerations

• The motor component of the GCS has been shown to be the most predictive element for outcomes 2, and in this case, the patient's ability to localize pain (M=5) is a relatively favorable sign
• The patient's confused verbal response may be influenced by the head trauma but could also be affected by other factors such as intoxication, which should be considered when interpreting GCS scores 1
• The National Expert Panel on Field Triage recommends that patients with moderate TBI receive a high level of trauma care 3

Common Pitfalls to Avoid

• Failing to assess all three components separately before calculating the total score can lead to inaccurate clinical decision-making 1
• Misinterpreting disorientation due to possible intoxication or other causes 1
• Not performing serial assessments to monitor for neurological deterioration 1
• Relying solely on the total score without considering the individual components 1

The GCS assessment should be repeated frequently in this patient to monitor for any deterioration, which would warrant immediate intervention and potentially repeat brain imaging 3, 1.