GCS Score Calculation
The GCS score for this patient is 8 (Eyes = 2, Verbal = 2, Motor = 4), placing them in the severe traumatic brain injury category that requires immediate critical care intervention and close neurological monitoring. 1
Score Breakdown
Based on the standardized GCS scoring table, this patient's components are:
- Eye Opening = 2: Opens eyes in response to painful stimuli 1
- Verbal Response = 2: Makes incomprehensible sounds (unintelligible sounds noted) 1
- Motor Response = 4: Flexion/withdrawal to painful stimuli (withdraws to pain) 1
Total GCS = 8 1
Clinical Significance and Immediate Actions
This GCS of 8 indicates severe traumatic brain injury (GCS ≤8) requiring immediate transport to a trauma center and consideration for neurosurgical intervention. 2
- Any patient with GCS <14 meets critical physiologic criteria requiring immediate transport to a trauma center, with documented mortality rates of 24.7% for this population 2, 3
- A GCS of 8 specifically falls within the severe TBI category where airway protection becomes critical, as most patients with GCS ≤8 require intubation 1
Essential Monitoring Requirements
Serial GCS assessments provide substantially more valuable clinical information than single determinations, with declining scores indicating poorer prognosis. 2, 3
- Monitor GCS every 15 minutes during the first 2 hours, then hourly for the following 12 hours per Scandinavian protocols 3
- Document individual E, V, and M scores separately at each assessment rather than just the sum, as patients with identical total scores but different component profiles have vastly different outcomes 2, 3, 4
- A decrease of at least two points in GCS score should prompt immediate repeat CT scanning 2, 3
- Pupillary size and reactivity must be documented at each assessment as key prognostic indicators 2, 3
Critical Pitfalls to Avoid
Never rely solely on the GCS score for clinical decision-making, particularly regarding treatment limitations. 2
- Account for confounding factors including sedation, intubation, facial trauma, intoxication, and metabolic disturbances that may affect GCS accuracy 2, 3
- The motor component has the highest predictive value and remains most robust even in sedated patients 3
- All GCS total scores between 4-14 can be associated with more than one disorder of consciousness diagnosis, with greatest variability observed for scores of 7-11 4
- The GCS was originally designed for comatose patients and serial evaluations, not for single-point severity determination 1, 2