What GCS score indicates severe traumatic brain injury and what initial steps are typically taken?

What GCS score indicates severe traumatic brain injury and what initial steps are typically taken?

• A. GCS ≤ 8; observation and delayed imaging if stable.
• B. GCS ≥ 13; observation only.
• C. GCS 9-12; immediate neurosurgical consult.
• D. GCS ≤ 3; discharge home after brief observation.

Answer: (D)

Severe traumatic brain injury is defined by a Glasgow Coma Scale score of 8 or less. This low score signals a high risk of airway compromise and rapid deterioration, so the immediate priority is to prevent secondary brain injury. The first steps are to secure the airway and protect the spine (often with rapid sequence intubation if the patient cannot protect their airway and with cervical immobilization), ensure adequate breathing and circulation, and treat hypotension promptly to maintain cerebral perfusion. An emergent non-contrast head CT should be obtained to look for hemorrhage, mass effect, fractures, or edema, and neurosurgery should be consulted right away if imaging shows injury or if there are signs of deterioration. Continuous neurologic monitoring is essential, and intracranial pressure monitoring may be considered in appropriate patients. Discharging after brief observation would not be appropriate for someone with a GCS in the severe range; urgent evaluation and intervention are needed.

Severe traumatic brain injury is defined by a Glasgow Coma Scale score of 8 or less. This low score signals a high risk of airway compromise and rapid deterioration, so the immediate priority is to prevent secondary brain injury. The first steps are to secure the airway and protect the spine (often with rapid sequence intubation if the patient cannot protect their airway and with cervical immobilization), ensure adequate breathing and circulation, and treat hypotension promptly to maintain cerebral perfusion. An emergent non-contrast head CT should be obtained to look for hemorrhage, mass effect, fractures, or edema, and neurosurgery should be consulted right away if imaging shows injury or if there are signs of deterioration. Continuous neurologic monitoring is essential, and intracranial pressure monitoring may be considered in appropriate patients. Discharging after brief observation would not be appropriate for someone with a GCS in the severe range; urgent evaluation and intervention are needed.