Glasgow Coma Scale

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. [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.

Instructions

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.

For reference only:

Score	6	5	4	3	2	1
EYE Response			Spontaneous	To Speech	To Pain	None
MOTOR Response	Obeys Command	Localizes Pain	Withdraws to Pain	Abnormal Flexion	Abnormal Extension	None
VERBAL Response		Oriented	Confused	Inappropriate words	Incomprehensible sounds	None
VERBAL Response -Ventilated		Appears Oriented		? Oriented		No response

Special Cases

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 cannot speak but are communicating

Patients who are aphasic or intubated but clearly can communicate in writing should be coded as functioning normally for Verbal assessment.

Sedated or Paralyzed Patients

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.

Discussion

• 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 prior to sedation or paralysis 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.

• Even if my version is not adopted, we do need to state how to score in case of brain injury. Ttenbergen 17:15, 18 June 2008 (CDT)Use GSC to assess brain injury.

• This was touched upon in the Category:Critical Care Review Group. Ttenbergen 14:08, 16 October 2008 (CDT)

• The important thing to keep in mind when doing apache GCS is that it focuses on the first 24 hours. If a patient comes in sedated,and remains sedated for the first 24 hours and there is clear documentation about GCS just prior to sedation (for example in ER), then you can use this information. If the patient is sedated and there is no documented GCS prior to sedation, you can use once the sedation is reduced if it is close to the 24 hour mark. Otherwise, if it is days later, there is no guarantee that this was correct during the first 24 hours. The guidelines say to put the value as normal if unable to obtain this information close to the 24 hour timeframe.--LKolesar 12:09, 17 October 2008 (CDT)

• In terms of patients where brain injury is in question and the pt. remains sedated for several days, therefore making an accurate determination of GCS impossible, we are still debating as to whether a normal GCS should be used. This is being worked on by the task group and the potential may be that we leave the GCS blank. Right now however, until we have a definite guideline, according to Trish, we should be using our own judgement as far as assessment once the sedation is worn off. --LKolesar 13:02, 17 October 2008 (CDT)
  • For purposes of calculating scores off the GCS, would leaving it blank result in a score as if coded as "normal"?Ttenbergen 13:28, 17 October 2008 (CDT)

Patients following drug overdose where outcome uncertain

Discussion

What should be coded for patients who had a drug overdose where the outcome is not clear during the GCS time frame? Ttenbergen 14:10, 16 October 2008 (CDT)

Template:Discussion

Discussion

• see entries above.Ttenbergen 14:09, 16 October 2008 (CDT)
• Could we improve the definition to reduce the special cases. Ttenbergen 14:13, 16 October 2008 (CDT)