ToolsCalculators
GCS-Pupils (GCS-P) Score
Glasgow Coma Scale combined with pupil reactivity for an extended index of TBI severity.
GCS-Pupils (GCS-P) Score
Eye opening (E)
Verbal response (V)
Motor response (M)
Pupil reactivity
Number of pupils unreactive to light.
Result15 points
GCS-P 15 falls in a range that roughly corresponds to mild-severity injury on the conventional GCS scale; lower GCS-P values track with progressively higher mortality and worse functional outcome after traumatic brain injury. The original derivation study treats GCS-P as a continuous severity/prognostic index rather than a formally defined categorical cutoff.
- Glasgow Coma Scale (E+V+M)
- 15
- Pupil reactivity score
- 0
- GCS-Pupils score
- 15
When to use
- Grading severity and estimating prognosis after traumatic brain injury alongside or instead of the GCS alone.
- Communicating combined consciousness and brainstem (pupillary) findings in a single ordinal score for trials or handover.
Formula
GCS-P = GCS (Eye + Verbal + Motor, 3-15) minus Pupil Reactivity Score (PRS). PRS = 0 if both pupils react to light, 1 if one pupil is unreactive, 2 if neither pupil reacts. GCS-P range is 1-15.
Pearls and pitfalls
- Developed from the IMPACT and CRASH databases to extend the GCS's prognostic range beyond its floor of 3.
- A GCS-P of 1 (GCS 3 with both pupils unreactive) identifies a subset with especially poor prognosis that GCS 3 alone does not distinguish.
- Assess pupils before sedation or paralytics are given whenever possible, since these can transiently affect reactivity.