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Glasgow Coma Scale: Difference between revisions

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The '''Glasgow Coma Scale''' is a ... [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale]
<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 Scale is used to calculate the [[:Category:APACHE II|APACHE II]] score and the [[MOST]] score.
* 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.  
* The '''data collector''' will enter the GCS as per [[Selection and timing of APACHE components]]


The possible values stored as dropdown lists on your PDA and in Access are as follows:
== 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.


{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
===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'''.


|-  align="center" valign="top"
=== Patients with normally limited communication ability===
|style="background-color:#CCCCE6" width="125" height="27" | '''Score'''
For patients whose ability to communicate are reduced due to '''pre-existing conditions''', score as fully functioning if they are able to function at the level that is '''normal for this patient'''. (e.g. Down's syndrome)
| width="64" | '''6'''
| width="58" |''' 5'''
| width="48" | '''4'''
| width="48" |''' 3'''
| width="48" | '''2'''
| width="48" | '''1'''


|-  align="center" valign="top"
=== Patients who fail assessments for reasons other than consciousness ===
|style="background-color:#CCCCE6" width="125" height="27" | '''Eyes'''
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.
| width="64" | &nbsp;
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
| width="58" | &nbsp;
| width="48" | Spontaneous
| width="48" | To


Speech
==GSC dropdown list and scores ==
| width="48" | To
=== Best Eye ===
* stored in the [[AP_Eye field]]:
{| class="wikitable" border=1
|-
|| ''Value'' || ''Points''
|-
|| 1 none || 1
|-
|| 2 to pain || 2
|-
|| 3 to speech || 3
|-
|| 4 spontaneous || 4
|}


Pain
=== Best Motor ===
| width="48" | None
* stored in the [[AP_Motor field]]
 
{| class="wikitable" border=1
|-  align="center" valign="top"
|-  
|style="background-color:#CCCCE6" height="39" | '''Motor'''
|| ''Value'' || ''Points''
  | Obeys
|-  
 
|| 1 None
Command
|| 1
| Localizes
|-
 
|| 2 abn. extension
Pain
|| 2
| Withdraws
|-  
 
|| 3 abn. flexion
to Pain
|| 3
| Abnormal
|-
 
|| 4 withdraws to pain
Flexion
|| 4
| Abnormal
|-  
 
|| 5 localizes pain
Extension
|| 5
| None
|-
 
|| 6 obeys commands
|- align="center" valign="top"
|| 6
|style="background-color:#CCCCE6" height="38" | '''Verbal'''
|}
| &nbsp;
| Oriented
| Confused
| Inappropriate
 
words
| Incomprehensible
 
sounds
| None
 
|- align="center"  valign="top"
|style="background-color:#CCCCE6" height="38" | '''Verbal vented'''
| width="48" | &nbsp;
| width="48" | Appears Oriented
| width="48" | &nbsp;
| width="48" | ? Oriented
| width="48" | &nbsp;
| width="48" | No response


=== Best Verbal ===
* stored in the [[AP_Verbal field]]
{| class="wikitable" border=1
|-
|| ''Value'' || ''Points''
|-
|| 1  oriented + conv.|| 5
|-
|| 2 disoriented + conv. || 4
|-
|| 3 inappropriate words || 3
|-
|| 4 incomp. Sounds || 2
|-
|| 5 no response || 1
|-
|| 6 ''ventilated''-appear oriented || 5
|-
|| 7 ''ventilated''-?questionably oriented || 3
|-
|| 8 ''ventilated''-no response || 1
|}
|}


== Special Cases ==
== Implementation ==
* For patients whose ability to communicate are reduced due to '''pre-existing conditions''', score as fully functioning if they are able to function at the level that is '''normal for this patient'''. (e.g. Down's syndrome)
In CCMDB:
 
* L_Log populated by lookup from [[s_GCS table]]:
* Patients who are '''aphasic''' or '''intubated''' but clearly '''responsive''' or can communicate in '''writing''' should be coded as functioning normally.  
**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"
* (there is a case of patients LOC reduced due to meds and how that should be coded normal as well - details anyone?)
**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'''
 
{{Discussion}}
 
== Discussion ==
* proper entry required in "special cases" for (there is a case of patients LOC reduced due to meds and how that should be coded normal as well - details anyone?) [[User:Ttenbergen|Ttenbergen]] 14:14, 18 June 2008 (CDT)
 


== 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.
*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]
*http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] OR [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale regular wikepedia which is needlessly verbose]
*http://reference.medscape.com/calculator/glasgow-coma-scale


== Related articles ==
{{Related Articles}}


{{stub}}
[[Category:APACHE II Physiological Variables]]
[[Category: Data Collection Guide]]
[[Category:ALERT Scale Elements]]
[[Category:APACHE II]]
[[Category:Glasgow Coma Scale | *]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=Glasgow_Coma_Scale"