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 | The '''Glasgow Coma Scale''' (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciousness. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale] | ||
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. | 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 worst GCS in the first 24hrs (like all other APACHE elements). | ||
== Instructions == | == Instructions == | ||
Select the '''worst''' Eye, Motor or Verbal response in the '''first 24''' hours after admission to '''ICU''' from the dropdown lists in CCMDB. | Select the '''worst''' 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 our purpose for the GCS is to understand what the state of consciousness was, and how it should impact, the APACHE score, i.e. the status of the patient within the first 24hrs. | |||
=== 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 | === 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 | 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] | |||
=== 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 | ==GSC dropdown list and scores == | ||
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext> | {| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext> | ||
|- style="font-weight:bold" | |- style="font-weight:bold" | ||
|- style="font-size:11pt;font-weight:bold" | |- style="font-size:11pt;font-weight:bold" | ||
Revision as of 17:01, 6 December 2012
The Glasgow Coma Scale (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciousness. [1] The Glasgow Coma Score is also used as part of the 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 worst GCS in the first 24hrs (like all other APACHE elements).
Instructions
Select the worst Eye, Motor or Verbal response in the first 24 hours after admission to ICU from the dropdown lists in CCMDB.mdb.
Special Cases
The below are only meant to help you use your judgement keeping in mind that our purpose for the GCS is to understand what the state of consciousness was, and how it should impact, the APACHE score, i.e. the status of the patient within the first 24hrs.
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)
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. Same is true for patients whose eyes are swollen shut etc. [2]
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
| Eye | Points | |
| 1 | none | 1 |
| 2 | to pain | 2 |
| 3 | to speech | 3 |
| 4 | spontaneous | 4 |
| Motor | 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 |
| Verbal | 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 |