The Glasgow Coma Scale (GCS) with pupil responses provides a comprehensive method for assessing a patient's neurological status following an injury. This method evaluates four key responses: eye opening, verbal communication, motor actions, and pupil reactivity to light. Each of these categories is assigned a score based on a predefined scale, and the scores are summed to provide an overall picture of the patient's condition.

For eye opening response, the scoring is as follows:
- Opens eyes spontaneously: 4 points
- Opens eyes to a verbal command: 3 points
- Opens eyes to pain: 2 points
- No response: 1 point

Verbal response scoring is categorized by the clarity and relevance of speech:
- Fully oriented: 5 points
- Confused conversation: 4 points
- Inappropriate words: 3 points
- Incomprehensible sounds: 2 points
- No verbal response: 1 point

Motor response scoring assesses the patient's physical reactions to stimuli:
- Obeys commands: 6 points
- Purposeful movement in response to painful stimulus: 5 points
- Withdraws from pain: 4 points
- Abnormal flexion response to pain (decorticate posture): 3 points
- Abnormal extension posture (decerebrate posture): 2 points
- No motor response: 1 point

Pupil response evaluates the reactivity of pupils to light:
- Both pupils unreactive to light: 2 points
- One pupil unreactive to light: 1 point
- Both pupils reactive to light (normal): 0 points

The combined total score can range from 3 to 17. This composite score helps predict outcomes, such as the risk of mortality and unfavorable recovery following a 6-month period post-injury. Here are some interpretations linked to specific total scores:

- Score of 3 indicates a 40.92% risk of mortality and a 65.53% chance of an unfavorable outcome.
- Score of 5 shows a 32.57% risk of mortality and a 57.75% chance of an unfavorable outcome.
- Score of 8 correlates to a 20.04% risk of mortality and a 33.55% chance for an unfavorable outcome.
- Score of 12 results in a 9.43% risk of mortality and a 19.92% chance of an unfavorable outcome.
- Score of 15 indicates merely a 2.54% risk of mortality and an 11.75% chance of an unfavorable outcome.

This assessment provides valuable insights for healthcare professionals in determining the severity of a patient's condition and potential clinical outcomes.

The GCS-pupils score is a clinical tool designed for assessing the severity of brain injury and predicting the 6-month post-injury mortality and unfavorable outcome rates. It is an extension of the Glasgow Coma Scale (GCS), with the addition of pupil reactivity to light, which has been shown to have prognostic value in traumatic brain injury.

The primary components of the GCS-pupils score include the patient's eye opening response, verbal response, motor response, and pupil response. Each of these components is scored based on the patient's observed behavior, with higher scores indicating better neurological function. The eye opening response is scored from 1 (no response) to 4 (spontaneous), the verbal response from 1 (no verbal response) to 5 (oriented), and the motor response from 1 (no motor response) to 6 (obeys commands). The pupil response is scored as -2 if both pupils are unreactive to light, -1 if one pupil is unreactive, and 0 if both pupils are reactive.

The total GCS-pupils score is calculated by summing the scores for the eye opening, verbal, and motor responses, and then subtracting the score for the pupil response. This total score can range from 1 to 15, with lower scores indicating a higher risk of 6-month post-injury mortality and unfavorable outcome. For example, a patient with a GCS-pupils score of 1 has a 74.45% risk of 6-month post-injury mortality and an 89.59% risk of unfavorable outcome, while a patient with a score of 15 has a 2.54% risk of 6-month post-injury mortality and an 11.75% risk of unfavorable outcome. 

This scoring system provides clinicians with a standardized method for assessing the severity of brain injury and predicting patient outcomes, which can guide treatment decisions and facilitate communication about the patient's condition and prognosis.