GCS-Pupils Score

GCS-Pupils Score Calculator
Eye Opening Response
Verbal Response
Motor Response
Pupil Reactivity
GCS-Pupils Score: –
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Select all four components to compute the GCS-P score.
Combines GCS and pupil reactivity for greater accuracy at low GCS.

When to Use

Patients with traumatic brain injury.

Formula

GCS-Pupils Score = GCS Score - Pupil response, where GCS Score = Eye response + Verbal response + Motor response and other variables are as follows: Variable Points Eye response 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 Verbal response Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 No verbal response 1 Intubated 1 Motor response Obeys commands 6 Localizes pain 5 Withdrawal from pain 4 Flexion to pain 3 Extension to pain 2 No motor response 1 Pupil response Both pupils unreactive to light 2 One pupil unreactive to light 1 Both pupils reactive to light (normal) 0

Pearls / Pitfalls

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 ).

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 ).

More Information

GCS-Pupils Score Mortality at 6 months post-injury Unfavorable outcome (vegetative state or severe disability) at 6 months post-injury 1 74.45% 89.59% 2 64.62% 85.22% 3 40.92% 65.53% 4 39.47% 68.90% 5 32.57% 57.75% 6 24.97% 46.26% 7 19.17% 37.20% 8 20.04% 33.55% 9 18.75% 30.32% 10 17.35% 28.88% 11 11.60% 21.81% 12 9.43% 19.92% 13 7.07% 15.85% 14 5.64% 14.39% 15 2.54% 11.75%

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