Severe Traumatic Brain Injury
This patient has severe traumatic brain injury based on a Glasgow Coma Scale score of 7.
TBI Severity Classification
The current classification system for traumatic brain injury uses the Glasgow Coma Scale to stratify injury severity into three categories 1, 2:
With a GCS score of 7 (eyes = 2, verbal = 1, motor = 4), this patient clearly falls into the severe TBI category 2.
Clinical Implications of Severe TBI
Patients with severe TBI require immediate transport to a hospital with neurosurgical capabilities, with management focused on preventing secondary brain injury 4, 5:
- Airway protection and maintaining oxygen saturation >95% to prevent hypoxemia 4, 5
- Maintaining systolic blood pressure >110 mmHg to ensure adequate cerebral perfusion 4, 5
- Immediate non-contrast head CT scan without delay to identify intracranial injuries requiring surgical intervention 6, 4, 5
- Serial neurological assessments to monitor for deterioration 4, 3
Important Considerations for GCS Assessment
Document individual component scores (eye, verbal, motor) separately, as patients with identical sum scores but different component profiles may have different outcomes 1, 5, 3:
- The motor component has the highest predictive value in severe TBI 1, 5
- Serial GCS assessments provide substantially more valuable clinical information than single determinations 1, 5, 3
- A declining or persistently low score indicates poorer prognosis 1, 5
Critical Pitfalls to Avoid
Be aware that confounding factors can affect GCS assessment, including sedation, intubation, facial trauma, and intoxication 1, 5, 3. However, in this unrestrained passenger with a GCS of 7 and abnormal head CT, the severity classification is unambiguous—this is severe TBI requiring immediate neurosurgical consultation and intensive care management 6, 4.
The answer is D: Severe