What is the recommended frequency for assessing the Glasgow Coma Scale (GCS) in a patient with a GCS score of 10?

GCS Monitoring Frequency for ICU Patient with GCS 10

For a patient with GCS 10 admitted to the ICU, neurological assessments using the Glasgow Coma Scale should be performed every 15 minutes for the first 2 hours, then every hour for the following 4-12 hours, with the exact frequency determined by clinical stability and risk of deterioration.

Evidence-Based Monitoring Protocols

The frequency of GCS monitoring in patients with moderate traumatic brain injury (GCS 9-12) varies by international guidelines, but all emphasize intensive early monitoring due to significant risk of secondary neurological deterioration 1:

• Scandinavian protocol: Every 15 minutes during the first 2 hours, then hourly for the following 12 hours 1
• UK protocol: Every 30 minutes for the first 2 hours, then hourly during the 4 following hours 1
• Australian protocol: Hourly assessments 1

Rationale for Intensive Early Monitoring

Patients with moderate TBI (GCS 9-12) have a significant risk of secondary neurological degradation, making frequent early assessment critical for detecting deterioration. 1

Key monitoring principles include:

• Clinical examination must be repeated during initial management and continued after hospital admission to detect secondary neurological aggravation 1
• A decrease of at least two points in the GCS score or occurrence of secondary neurological deficit should prompt immediate repeat CT scanning 1
• Serial GCS assessments provide substantially more valuable clinical information than single determinations, with declining scores indicating poorer prognosis 2, 3

Recommended Assessment Components

The GCS should be routinely performed in comatose adult patients with acute brain injury, combined with assessment of pupils. 1

Document the following at each assessment:

• Individual component scores (Eye, Motor, Verbal) rather than just the sum score, as patients with identical totals but different component profiles may have different outcomes 2, 3
• Pupillary size and reactivity, which are key prognostic indicators 1
• The motor component, which has the highest predictive value and remains robust even in sedated patients 1, 2

Critical Clinical Pitfalls to Avoid

Do not rely on a single GCS determination—serial assessments are essential for monitoring trends and detecting deterioration. 2, 3

Additional considerations:

• Recognize confounding factors that may affect GCS assessment, including sedation, intubation, facial trauma, and intoxication 2, 3
• In patients with GCS <14, mortality rates reach 24.7%, emphasizing the need for vigilant monitoring 4
• The rhythm of recurrent examination is left at the discretion of the in-charge physician but must be continued systematically 1

Answer to the Question

Based on the most rigorous international guidelines, the answer is A (Every 15 minutes) for the initial 2-hour period, followed by hourly assessments. 1 This represents the Scandinavian protocol, which provides the most intensive early monitoring for patients at risk of deterioration. While some protocols use 30-minute or hourly intervals from the start, the 15-minute frequency during the critical first 2 hours offers the earliest detection of neurological changes in this moderate TBI patient with GCS 10.