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Wed Sep 5 21:15:51 BST 2007

You forgot "none of the above."  
First, get rid of the "T's."  The functional value of the GCS is
strictly numerical.  If you have to add a "T," you're giving up on the
verbal axis, and the total score is invalid.  
(For practical purposes you can default to the motor score as a frame of
reference for serial exams.  Most of the value of the GCS is in there
anyway.)
Think about you're trying to achieve: a simple quantification of his
level of consciousness.  In the same way you can (and MUST) give a Motor
score of 6 to an alert quadriplegic ("Blink you're eyes three times" or
"Touch your tongue to your upper lip") you can sometimes credit a decent
verbal score to an intubated (or otherwise mute) patient: for example,
if he can mouth yes and no accurately to simple questions, I'd give him
a 5 for verbal.
Consider though that having a verbal score higher than your motor score
is a neat trick.  If he's not paralyzed, your guy's probably got a GCS
of 3.  Then you have to be certain that the score is endogenous and not
pharmacologic -- unresponsiveness is sometimes a treatment goal, after
all.
For the purposes of data collection, I usually recommend that at least
one initial GCS can be tabulated from behaviors just prior to
intubation.  This is particularly important in the prehospital phase.
It's an important data element in the registry, and frequently a
prognostic hint.
Hope this is helpful.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Simon
Sent: Wednesday, September 05, 2007 2:37 PM
To: Trauma &amp; Critical Care mailing list
Subject: GCS scoring question

Just a quick question for the group.
What is the GCS of this patient:
No spont eye opening
No movt to deep pain
Intubated
Is it 3, 3T or 2T?
Thanks
ron simon

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GCS scoring question