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Glasgow Coma Scale: Difference between revisions

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The '''Glasgow Coma Scale''' (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciouness following a traumtic brain injury. [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 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.


== Instructions ==
* 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.
Select the '''best''' Eye, Motor or Verbal response in the '''first 24''' hours after admission to '''ICU''' from the dropdown lists on your PDA and in Access.
* 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]]
For reference only:
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>


|-  align="center" valign="top"
== Special Cases ==
|style="background-color:#CCCCE6" width="125" height="27" | '''Score'''
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.
| width="64" | '''6'''
| width="58" |''' 5'''
| width="48" | '''4'''
| width="48" |''' 3'''
| width="48" | '''2'''
| width="48" | '''1'''
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" width="125" height="27" | '''EYE''' Response
| width="64" | &nbsp;
| width="58" | &nbsp;
| width="48" | Spontaneous
| width="48" | To
 
Speech
| width="48" | To
 
Pain
| width="48" | None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="39" | '''MOTOR''' Response
| Obeys
 
Command
| Localizes
 
Pain
| Withdraws
 
to Pain
| Abnormal
 
Flexion
| Abnormal
 
Extension
| None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="38" | '''VERBAL''' Response
| &nbsp;
| Oriented
| Confused
| Inappropriate
 
words
| Incomprehensible
 
sounds
| None
 
|- align="center"  valign="top"
|style="background-color:#CCCCE6" height="38" | '''VERBAL''' Response -'''Ventilated'''
| width="48" | &nbsp;
| width="48" | Appears Oriented
| width="48" | &nbsp;
| width="48" | ? Oriented
| width="48" | &nbsp;
| width="48" | No response
 
|}


== Special Cases ==
===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===
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)
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)


=== Patients who cannot '''speak''' but are communicating ===
=== Patients who fail assessments for reasons other than consciousness ===
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally for Verbal assessment.  
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]


=== Sedated or Paralyzed Patients ===
==GSC dropdown list and scores ==
For non-neuro and post operative patients who are sedated or paralyzed, record a '''normal'' GCS score unless there are concerns in regards brain injury.  Sedation does not allow us to accurately assess neuological status therefore we use alternative information that was documented prior to OR or sedation or we use our "best guess" based on chart notes.
=== 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
|}


====Discussion====
=== Best Motor ===
* I think that one might weave back and forth too much and be a bit hard to read. How about this:
* stored in the [[AP_Motor field]]
{| class="wikitable" border=1
|-
|| ''Value'' || ''Points''
|- 
|| 1 None
|| 1
|-
|| 2 abn. extension
|| 2
|-
|| 3 abn. flexion
|| 3
|-
|| 4 withdraws to pain
|| 4
|-
|| 5 localizes pain
|| 5
|-
|| 6 obeys commands
|| 6
|}


Being sedated or paralyzed may not allow us to accurately assess neurological status. For '''sedated''' or '''paralyzed''' patients consider their likely neurological status prior to sedation or paralysis or status when sedation wears off.
=== Best Verbal ===
* when using information that was '''documented prior to sedation/paralysis''' or POST OP use "best guess" based on chart notes.
* stored in the [[AP_Verbal field]]
 
{| class="wikitable" border=1
* Even if my version is not adopted, we do need to state how to score in case of brain injury. [[User:Ttenbergen|Ttenbergen]] 17:15, 18 June 2008 (CDT)Use GSC to assess brain injury.
|-
 
|| ''Value'' || ''Points''
* This was touched upon in the [[:Category:Critical Care Review Group]]. [[User:Ttenbergen|Ttenbergen]] 14:08, 16 October 2008 (CDT)
|-
 
|| 1  oriented + conv.|| 5
{{Discussion}}
|-
 
|| 2 disoriented + conv. || 4
== 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)
|| 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
|}


*How do we classify drug overdoses,when the outcome isn't clear?
== 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 ==
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 | *]]
[[Category:Critical Care Review Group]]
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