Week 5

Context

Although not an essential part of the NEWS score, the Royal College of Physicians recommend the use of the Glasgow Coma Scale or disease specific systems as dictated by patient need. The Glasgow Coma Scale (GCS) was described in 1974 by Graham Teasdale and Bryan Jennett, as a way to communicate about the level of consciousness of patients with an acute brain injury.

The Scale should be used, either alone or in addition to AVPU ,in a patient suspected of an intracranial lesion.The findings using the scale guide initial decision making and monitor trends in responsiveness that are important in signalling the need for new actions.

The goal of a new structured approach, described in 2014, to assessment of the Glasgow Coma Scale is to ensure standardised, consistent practice and to promote the reliability of its use through education.
This has been achieved by more clearly defining the steps taken in assessing each component of the scale.

Content

The Glasgow Coma Scale is based on three components of the patient’s responsiveness : the eye opening, verbal and motor responses. Each is assessed, described and recorded separately.Within each component there are a number of steps that reflect increasing deterioration in the patient’s level of consciousness.

Numbers can be allocated to the steps in the scale and added into a total Glasgow Coma Score. The lowest score for each category is 1, so that the lowest total score is 3 (no response to pain + no verbalisation + no eye opening).The highest total is 15, (spontaneous eye opening, orientated and obeying commands). The total score conveys less information than the three components and therefore these should be used when describing an individual patent. Note, it is advisable that when documenting the score, you also should a description of the response, rather than just the overall score.

New guidance on the use of the Glasgow Coma Scale is provided by Professor Teasdale and his team, in a dedicated website; www.glasgowcomascale.org.

This contains information on the make up of the scale, on recent developments, answers to frequent questions and presents a video that takes you through the new structured approach to using the scale. There is also a self test and a guide you can download .

References and Further Reading

Teasdale, G. and Jennett, B. (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 pp 81-4

Teasdale G. Maas, A. Lecky, F. Manley, G Stocchetti, N. and Murray, G ( 2014)The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurology. 13: 844 – 855

Teasdale, G. Allan, D. Brennan, p. McElhinney,m E. MacKinon, L.9 2014) 40 years on: updating the Glasgow Coma Scale . Nursing Times 110 12 -16

Teasdale, G. (2014) The Glasgow structured approach to assessment of the Glasgow Coma Scale. www.glasgowcomascale.org