Episode 5 – Glasgow Coma Scale

A physical therapist assesses a patient with a traumatic brain injury using the Glasgow Coma Scale. If the therapist documents the eye opening score as a three, which of the following responses was observed during this portion of the assessment?

1. Spontaneous eye opening
2. Eyes open in response to speech 
3. Eyes open in response to pain
4. Eyes do not open (nil response)
 

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders Team with the opportunity to explore challenging multiple choice examination questions with students actively preparing for the licensing examination.

My name is Scott Giles and I will be your host for today’s journey. 

How are you doing today? Feeling good, full of optimism, and in general just happy to be alive? Excellent, your enthusiasm makes me very happy!

Ready? Let’s go! 

A physical therapist assesses a patient with a traumatic brain injury using the Glasgow Coma Scale. If the therapist documents the eye opening score as a three, which of the following responses was observed during this portion of the assessment?

1. Spontaneous eye opening
2. Eyes open in response to speech 
3. Eyes open in response to pain
4. Eyes do not open (nil response)

Wow! I am not psychic but I just sensed a serious mood change.

If there was an index that allowed us to rate how picky a question is from 1-10, this particular question would be darn close to a 10.

I’ll be honest with you, there is no way I would have remembered this information without reviewing it. At some point I did know this, but there is only so much information that I can retain and have readily available for use. Look, we all have moments of brilliance and moments of something less than brilliance. Let me share a recent less than brilliant moment for me. 

I was writing a thank you note and at some point I needed to write the word “WAS” and I just sat there staring at the paper. I eventually wrote the word correctly but had serious doubts if this was in fact accurate. I challenge any of you to look closely at this word and tell me with 100% accuracy that this is the correct spelling.

I am sure this seems like lunacy to some of you and in retrospect it does to me as well. The bottom line is that if I am presently functioning at this level, how on earth am I supposed to know the observed response associated with an eye opening score of three on the Glasgow Coma Scale. Good Grief! Attempt to graciously accept your moments of brilliance and tolerate an occasional less than brilliant blip. 

Let’s review what we know about the Glasgow Coma Scale.

Glasgow Coma Scale
The Glasgow Coma Scale is a neurological assessment tool used initially after a traumatic brain injury to determine the patient’s level of consciousness and the severity of the injury. The Glasgow Coma Scale is scored based on the patient’s ability to open their eyes, motor response, and verbal response. A total score of eight or less correlates to severe brain injury and coma in 90% of patients. Scores of 9 to 12 indicate moderate brain injuries and scores from 13 to 15 indicate mild brain injuries.

I think an objective person would agree that this is fairly good breadth and depth on this topic. However, given that we assigned a pickiness rating of nearly 10, this level of information remains inadequate.

Let’s go deeper and examine the specific scoring levels in each of the three areas. 

Eye Opening
The ability of the patient to open their eyes is scored from a 1 to a 4. This information is the key critical academic content to answer this question.

Motor Response
Motor response is scored from a 1 to a 6.

Verbal Response
Verbal response is scored from a 1 to a 5.

The cumulative score on the Eyes, Motor, and Verbal components determine a patient’s score on the Glasgow Coma Scale.

Let’s explore each of the options:

Option 1 - Spontaneous eye opening
The eye opening subscale is scored on a range from 1-4. A patient who can open their eyes spontaneously would be given a score of 4.

Option 2 - Eyes open in response to speech 
A patient who can open their eyes in response to speech would be given a score of 3. This is typically assessed by speaking to the patient using their name.

Option 3 - Eyes open in response to pain
A patient who opens their eyes only in response to pain would be given a score of 2. This is typically assessed by applying pressure to either one of the patient’s fingertips or supraorbital notch, or by squeezing one of the patient’s trapezius muscles.

Option 4 - Eyes do not open (nil response)
A patient who does not open their eyes to a painful stimulus (nil response) would be given a score of 1.

The correct answer is Option 2

Let’s explore the all student data:

17% of students selected Option 1, Spontaneous eye opening
56% of students selected Option 2, Eyes open in response to speech, the correct response
24% of students selected Option 3, Eyes open in response to pain
4% of students selected Option 4, Eyes do not open (nil response)

Considering the difficulty level of the question, I am fairly impressed that 56% of students answered the question correctly. Even in questions this difficult, there are always deductive reasoning strategies that can be applied. For example, the question indicates that the therapist documented the patient’s eye opening score as a three.

Under almost any scenario, it seems logical to me that a score of three would represent more than the eyes not opening (nil response). Look, this type of decision making is not ideal but it is far better than random guessing. I feel many students were able to apply this same type of logic which is why only 4% of students selected option 4.

Use the All Students’ Results to determine how mainstream your thinking is and to identify where opportunities may have existed to apply deductive reasoning strategies.

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which also represents approximately 24% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards. 

Academic Focus Area
Looking to review related academic content? Page 313 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/6YYyrVzLBY0?si=h7f8n2mrYxhaRnFd