Assessing the patient

The management of individual brain-injured patients, and the formulation and application of guidelines, depends upon the use of a widely accepted and applicable method of assessment and classification of the level of consciousness. The Glasgow Coma Scale, and its derivative the Glasgow Coma Score, are widely used for assessing patients before and after arrival at hospital (Table 2.1). Many studies support their repeatability, validity, and clinimetric properties.51

The Glasgow Coma Scale provides a framework for describing the state of the patient in terms of three aspects of responsiveness: eye opening, best motor response, and verbal response, each stratified according to increasing impairment. The distinction between normal and abnormal flexion can be difficult to make consistently and is rarely useful in monitoring the individual patient; it is, however, relevant to prognosis and is therefore used to classify severity in groups of patients. The Glasgow Coma Score can provide a single summary figure and a basis for systems of classification but contains less information than a description separately of the three responses. The three responses of the original scale, not

Table 2.1 The Glasgow Coma Scale and Score

Feature

Scale

Score

Eye opening

Spontaneous

4

To speech

S

To pain

2

None

1

Verbal response

Orientated

5

Confused conversation

4

Words (inappropriate)

S

Sounds (incomprehensible)

2

None

1

Best motor response

Obeys commands

e

Localises to pain

5

Flexion

Normal

4

Abnormal

S

Extension

2

None

1

Total Coma Score

Data from Teasdale et al.71

(sum score)

Data from Teasdale et al.71

the total score, should be used in describing, monitoring, and exchanging information about individual patients.

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