Glasgow Coma Scale: Difference between revisions

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(→‎Medicated/Sedated Patients: This is duplication of the section #Special notes regarding sedated patients: and it is inconsistent with that. And we are stopping GCS sedated field)
 
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The '''Glasgow Coma Scale''' (GCS) is a neurological assessement 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], [http://simple.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 APACHE II (Critical Care) and MOST (Medicine) assessment score. [[: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]]


*Select the '''BEST''' Eye, Motor or Verbal response in the first 24 hours of ICU admission.
==Special notes regarding 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'''.


The possible values are 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>
=== 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)


|-  align="center" valign="top"
=== Patients who fail assessments for reasons other than consciousness ===
|style="background-color:#CCCCE6" width="125" height="27" | '''Score'''
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.
| width="64" | '''6'''
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
| width="58" |''' 5'''
| width="48" | '''4'''
| width="48" |''' 3'''
| width="48" | '''2'''
| width="48" | '''1'''


|-  align="center" valign="top"
==GSC dropdown list and scores ==
|style="background-color:#CCCCE6" width="125" height="27" | '''Eyes'''
=== Best Eye ===
| width="64" | &nbsp;
{| class="wikitable" border=1
| width="58" | &nbsp;
|-  
| width="48" | Spontaneous
|| ''Value'' || ''Points''
| width="48" | To
|-
|| 1 none || 1
|-
|| 2 to pain || 2
|-
|| 3 to speech || 3
|-
|| 4 spontaneous || 4
|}


Speech
=== Best Motor ===
| width="48" | To
{| class="wikitable" border=1
 
|-  
Pain
|| ''Value'' || ''Points''
| width="48" | None
|-  
 
|| 1 None
|- align="center" valign="top"
|| 1
|style="background-color:#CCCCE6" height="39" | '''Motor'''
|-
  | Obeys
|| 2 abn. extension
 
|| 2
Command
|-  
| Localizes
|| 3 abn. flexion
 
|| 3
Pain
|-
| Withdraws
|| 4 withdraws to pain
 
|| 4
to Pain
|-  
| Abnormal
|| 5 localizes pain
 
|| 5
Flexion
|-
| Abnormal
|| 6 obeys commands
 
|| 6
Extension
|}
| None
 
|- align="center" valign="top"
|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 ===
{| 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"
**For non neuro and post operative patient who are sedated or paralyzed, record a NORMAL GSC score unless there are concerns in regards brain injury of some sort. 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.
*** '''The list sorting numbers for this one are opposite to scoring'''
*** I think that one might weave back and forth too much and be a bit hard to read. How about this:
 
Being sedated or paralyzed may not allow us to accurately assess neurological status. For '''sedated''' or '''paralyzed''' patients consider their likely neurological status once  prior to sedation or paralyzis or status when sedation wears off.
* when using information that was '''documented prior to sedation/paralysis''' or POST OP use "best guess" based on chart notes
* if there is any sign of '''brain injury''', score '''<how>'''  
 
 
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)
{{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)
 
*How do we classify drug overdoses,when the outcome isn't clear?


== 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 | *]]

Latest revision as of 15:53, 2021 June 15

The Glasgow Coma Scale (GCS) ([1], [2]) is a commmon neurological assessment scale used to quantify 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.

  • The Glasgow Coma Score is also used as part of the 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

Special notes regarding sedated patients:

  1. 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.
  2. 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.
  3. If a non-sedated GCS is unavailable in the first 24 hours, use the previous un-sedated GCS if possible.
  4. If there is absolutely no un-sedated GCS available (e.g. Lost/missing chart), default to a normal GCS.

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.

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. [3]

GSC dropdown list and scores

Best Eye

Value Points
1 none 1
2 to pain 2
3 to speech 3
4 spontaneous 4

Best Motor

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

Best Verbal

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

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.

Related articles

Related articles:
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