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    GCS-Pupils Score

    Combines GCS and pupil reactivity for greater accuracy at low GCS.
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    When to Use
    Pearls/Pitfalls

    Patients with traumatic brain injury.

    • Retrospectively derived, based on pooled data from two large databases, IMPACT and CRASH. 
    • Addition of pupil data was shown to be particularly useful at very low GCS scores (3-4), likely because of higher frequency of abnormal pupil response in patients with severe TBI and low GCS (Brennan 2018).
    Eyes open spontaneously
    +4
    Eye opening to verbal command
    +3
    Eye opening to pain
    +2
    No eye opening
    +1
    Not assessable (trauma, edema, etc)
    +1
    Oriented
    +5
    Confused
    +4
    Inappropriate words
    +3
    Incomprehensible sounds
    +2
    No verbal response
    +1
    Intubated
    +1
    Obeys commands
    +6
    Localizes pain
    +5
    Withdrawal from pain
    +4
    Flexion to pain
    +3
    Extension to pain
    +2
    No motor response
    +1
    Both pupils unreactive to light
    -2
    One pupil unreactive to light
    -1
    Both pupils reactive to light (normal)
    0

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    Advice

    The GCS-Pupils Score is not intended to replace the GCS as a snapshot of an individual patient's condition and how it changes over time; the authors state it is meant to act as a supplement to add information about severity and prognosis (Brennan 2018).

    About the Creator
    Dr. Paul M. Brennan
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    Dr. Graham Teasdale
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