What is a Glasgow Coma Scale (GCS) score of 3?

From the Guidelines

GCS3 refers to the lowest score on the Glasgow Coma Scale, indicating a patient with severe neurological impairment, and immediate medical intervention is required to ensure the best possible outcome in terms of morbidity, mortality, and quality of life. A patient with GCS3 shows no eye opening, no verbal response, and no motor response to stimuli, representing the most critical level of unconsciousness, typically seen in patients with severe brain injury, deep coma, or those who are near brain death 1. When a patient presents with GCS3, securing the airway, maintaining adequate oxygenation and blood pressure, and rapid diagnostic imaging such as CT scan to identify the cause of the neurological deficit are crucial steps in management 1. The prognosis for patients with GCS3 is generally poor, though outcomes depend on the underlying cause, patient age, comorbidities, and time to treatment 1.

Key Considerations

• The Glasgow Coma Scale evaluates consciousness through three components: eye opening (scored 1-4), verbal response (scored 1-5), and motor response (scored 1-6), with a total possible score ranging from 3 to 15 1.
• Serial GCS scores are valuable in patients with mild TBI, as a low GCS score that remains low or a high GCS score that decreases predicts a poorer outcome 1.
• The use of a single GCS determination cannot be used solely in diagnosing mild TBI, and serial determinations are necessary to detect patients who require a neurosurgical procedure 1.
• Immediate medical intervention, including securing the airway and maintaining adequate oxygenation and blood pressure, is required to ensure the best possible outcome in terms of morbidity, mortality, and quality of life 1.

Management

• Securing the airway, often through intubation, is a critical step in managing patients with GCS3 1.
• Maintaining adequate oxygenation and blood pressure is essential to prevent further neurological deterioration 1.
• Rapid diagnostic imaging, such as CT scan, is necessary to identify the cause of the neurological deficit and guide further management 1.

From the Research

Definition of GCS3

• GCS3 refers to a score of 3 on the Glasgow Coma Scale (GCS), which is used to assess the severity of brain injury 2, 3.
• A GCS score of 3 indicates a severe brain injury and is associated with a poor prognosis 2.
• The GCS score is based on three components: eye opening, verbal response, and motor response 3.

Clinical Implications of GCS3

• Patients with a GCS score of 3 often have a high mortality rate, with one study reporting a mortality rate of 80.6% 2.
• However, some patients with a GCS score of 3 can still achieve a good outcome, with one study reporting that 14.5% of patients achieved a good outcome at 6 months 2.
• The use of interventions such as hypertonic saline and mannitol can help reduce intracranial pressure and improve outcomes in patients with severe brain injury, including those with a GCS score of 3 4, 5.

Assessment and Monitoring of GCS3

• The GCS score is an important tool for assessing the severity of brain injury and monitoring patient progress 3, 6.
• Other clinical monitoring scales, such as the FOUR score, can also be used to assess consciousness and monitor patient progress 6.
• Assessment of pain, agitation, and delirium is also important in patients with severe brain injury, including those with a GCS score of 3 6.