The Glasgow Coma Scale was first described in 1974 by Teasdale and Jennett. It remains the gold standard for assessing the depth and duration of impaired consciousness. However, the traditional score does not account for brainstem reflexes.
The GCS-Pupils (GCS-P) score integrates brainstem function with the standard GCS. It is calculated by subtracting the Pupillary Reactivity Score (PRS) from the GCS total:
Why it matters: A GCS of 3 with bilateral fixed pupils (GCS-P 1) carries a significantly worse mortality profile than a GCS of 3 with reactive pupils (GCS-P 3).
| Confounder | Clinical Strategy |
|---|---|
| Intubation & Sedation | Do not assign a score of 1 to Verbal if the patient is intubated. Assign "NT" (Not Testable) and append a "T" to the score (e.g., E4 VT M6). Daily sedation pauses are critical to establish a true baseline. |
| Periorbital Oedema | Common in severe maxillofacial trauma. Do not assign an Eye score of 1. Mark as "NT" with modifier "C" (Closed). |
| Aphasia / Dementia | Record the best baseline function. A patient with severe baseline aphasia cannot score a Verbal 5, but changes from their baseline indicate acute deterioration. |
According to Indian epidemiological data, road traffic accidents account for a vast majority of severe TBI presentations. Delayed transport to definitive neurosurgical centres often exacerbates secondary brain injury (hypoxia and hypotension). Strict adherence to basic airway protection protocols in the primary centre prior to transfer is paramount. Furthermore, in non-traumatic encephalopathies (like hepatic encephalopathy or severe CNS tuberculosis), the GCS trend over hours is far more predictive of outcome than a single isolated measurement.
AMA Style:
Umakanth S. Glasgow Coma Scale (GCS) & Neurological Assessment Pathway. MEDiscuss. Published 2026. Accessed .
Vancouver Style:
Umakanth S. Glasgow Coma Scale (GCS) & Neurological Assessment Pathway [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:
