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Glasgow Coma Scale: Difference between revisions

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The '''Glasgow Coma Scale''' (GCS) [http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html] or [*[http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciousness.  
<onlyinclude>The '''Glasgow Coma Scale''' (GCS) ([http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html], [https://en.wikipedia.org/wiki/Glasgow_Coma_Scale]) is a commmon neurological assessment scale used to quantify the level of consciousness in a person following a '''traumatic brain injury'''. </onlyinclude> Basically, it is used to help gauge the severity of an acute brain injury.  


The '''Glasgow Coma Score''' is also used as part of the [[:Category:APACHE II|APACHE II]] assessment score for Critical Care Program and the [[MOST]] assessment score for Medicine Program. Due to this use as part of APACHE we need the '''best''' GCS in the first 24 hrs (unlike all other APACHE elements). Consciousness is greatly affected by sedative drugs, and many/most patients get such drugs.  So being totally unconscious can easily be a result of being sedated, not brain-injured.  Since this issue is even bigger than the issue of waxing/waning mental status due to fluctuating/changing illness, we use the '''best''' value in the 1st 24 hrs.
* The '''Glasgow Coma Score''' is also used as part of the [[:Category:APACHE II|APACHE II]] assessment score for Critical Care Program and the [[ALERT Scale]] for Medicine Program.  
 
* The '''bedside nurses''' doing the GCS evaluation on the patient will record the best response.  
== Instructions ==
* The '''data collector''' will enter the GCS as per [[Selection and timing of APACHE components]]
Select the '''best''' Eye, Motor or Verbal response in the '''first 24''' hours after admission to '''ICU''' from the dropdown lists in [[CCMDB.mdb]].


== Special Cases ==
== Special Cases ==
The below are only meant to help you '''use your judgement''' keeping in mind that the purpose of the GCS is to assess the severity of a '''brain injury''', within the first 24hrs of admission.  
The below are only meant to help you '''use your judgement''' keeping in mind that the purpose of the GCS is to assess the severity of a '''brain injury''', within the first 24hrs of admission.  
===Sedated patients ===
<!-- These instructions were given by Dr Garland utilizing the APACHE manual created by APACHE Medical Systems. --[[User:LKolesar|LKolesar]] 09:02, 2013 January 16 (EST) -->
# If a pt is an overdose, use the worst score because the sedative effect and the potential injury to the brain due to the drug overdose is part of the acuity score.
# If a pt is heavily sedated, a GCS is not considered accurate, therefore, if possible, use the worst GCS done when the pt. is '''not''' on sedation in the first 24 hours.
# If a non-sedated GCS is unavailable in the first 24 hours, use the previous un-sedated GCS if possible. 
# If there is absolutely no un-sedated GCS available (e.g. [[Lost/missing chart]]), default to a '''normal GCS'''.


=== Patients with normally limited communication ability===
=== Patients with normally limited communication ability===
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Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.  
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.  
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
=== Medicated Patients ===
If a patient is unable to respond to GSC questions because they are medicated (e.g. sedated or paralyzed), and there is no reason to expect that their response would be impaired if they were not medicated, they can be scored to a GCS assessment immediately prior to medication if available, e.g. from the ER. If the patient is sedated and there is no documented GCS prior to sedation, you can use a GCS assessment once the sedation is reduced '''if''' it is close to the 24 hour mark.


==GSC dropdown list and scores ==
==GSC dropdown list and scores ==
=== Best Eye ===
=== Best Eye ===
* stored in the [[AP_Eye field]]:
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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=== Best Motor ===
=== Best Motor ===
* stored in the [[AP_Motor field]]
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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=== Best Verbal ===
=== Best Verbal ===
* stored in the [[AP_Verbal field]]
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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|| 8 ''ventilated''-no response || 1
|| 8 ''ventilated''-no response || 1
|}
|}
== Implementation ==
In CCMDB:
* L_Log populated by lookup from [[s_GCS table]]:
**ap_eye text(13) lookup "1 None;2 To Pain;3 To Speech;4 Spontaneous"
**ap_motor text(19) lookup "1 None;2 Abn. Extension;3 Abn Flexion;4 Withdraws to Pain;5 Localizes Pain;6 Obeys Commands"
**ap_verbal text(26) lookup "1 Oriented+Conv;2 Disoriented+Conv;3 Inappropriate Words;4 Incomp. Sound;5 No response;6 vented-appears oriented;7 vented-? oriented;8 vented-no response"
*** '''The list sorting numbers for this one are opposite to scoring'''


== Background ==
== Background ==
It is the most common scoring system used to describe the level of consciousness in a person following a '''traumatic brain injury'''. Basically, it is used to help gauge the severity of an acute brain injury.
It is the most common scoring system used to describe the level of consciousness in a person following a '''traumatic brain injury'''. Basically, it is used to help gauge the severity of an acute brain injury.
*[http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html]
*http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html
*From the other articles referenced,primarily [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2874%2991639-0/abstract]  
*From the other articles referenced,primarily [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2874%2991639-0/abstract]  
*[http://www.trauma.org/archive/scores/gcs.html]
*http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] OR [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale regular wikepedia which is needlessly verbose]
*[http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale]
*http://reference.medscape.com/calculator/glasgow-coma-scale
*[http://reference.medscape.com/calculator/glasgow-coma-scale]
 
== Related articles ==
{{Related Articles}}


[[Category: APACHE II Physiological Variables]]
[[Category:APACHE II Physiological Variables]]
[[Category: MOST Score Elements]]
[[Category:ALERT Scale Elements]]
[[Category:Glasgow Coma Scale | *]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=Glasgow_Coma_Scale"