词条 | Glasgow Coma Scale | |||||||||||||||||||||||||||
释义 |
| name = Glasgow Coma Scale | image = | alt = | caption = | pronounce = | synonyms = | DiseasesDB = | ICD10 = | ICD9 = | ICDO = | MedlinePlus = | eMedicine = | MeshID = D015600 | LOINC = {{LOINC|35088-4}} | reference_range = }} The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the state of a person's consciousness for initial as well as subsequent assessment. A person is assessed against the criteria of the scale, and the resulting points give a person's score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale). GCS was initially used to assess a person's level of consciousness after a head injury, and the scale is now used by emergency medical services, nurses, and physicians as being applicable to all acute medical and trauma patients. In hospitals, it is also used in monitoring patients in intensive care units. The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital. GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system. The initial indication for use of the GCS was serial assessments of people with traumatic brain injury[1] and coma for at least six hours in the neurosurgical ICU setting, though it is commonly used throughout hospital departments. The similar Rancho Los Amigos Scale, is used to assess the recovery of traumatic brain injury. GCS was updated following a review of the helpfulness and usefulness of the scale from clinicians. It was decided that several things required updating, like the Eye Response element, meaning that instead of responding to "Painful Stimuli" being regarded as a 2, a person that opens their eyes in response to pressure is now considered a 2 in the Eye Response element.[2] Elements of the scale
Note that a motor response in any limb is acceptable.[4] The scale is composed of three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (graded 1 in each element) is 3 (deep coma or death), while the highest is 15 (fully awake person). Eye response (E)There are four grades starting with the most severe:
Verbal response (V)There are five grades starting with the most severe:
Motor response (M)There are six grades:
InterpretationIndividual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35". Generally, brain injury is classified as:
Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. "E1c", where "c" = closed, or "V1t" where t = tube). Often the 1 is left out, so the scale reads Ec or Vt. A composite might be "GCS 5tc". This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for "abnormal flexion". The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently, the Pediatric Glasgow Coma Scale was developed for assessing younger children. Revisions
ControversyThe GCS has come under pressure from some researchers who take issue with the scale's poor inter-rater reliability and lack of prognostic utility.[8] Although there is no agreed-upon alternative, newer scores such as the Simplified motor scale and FOUR score have also been developed as improvements to the GCS.[9] Although the inter-rater reliability of these newer scores has been slightly higher than that of the GCS, they have not gained consensus as replacements.[10] See also
References1. ^{{cite journal |vauthors=Teasdale G, Jennett B | title=Assessment of coma and impaired consciousness. A practical scale. | journal=Lancet | year=1974 | volume= 2| issue=7872| pages=81–4| doi= 10.1016/S0140-6736(74)91639-0| pmid=4136544}} 2. ^{{cite web|url=http://www.glasgowcomascale.org/whats-new/|title=What's new - Glasgow Coma Scale|website=www.glasgowcomascale.org|access-date=2018-06-24}} 3. ^{{cite web|title=Glasgow Coma Scale|author=Russ Rowlett|publisher=University of North Carolina at Chapel Hill|url=http://www.unc.edu/~rowlett/units/scales/glasgow.htm}} 4. ^Hutchinson’s clinical methods 22nd edition 5. ^{{cite journal|journal=Emergency Nurse|title=The Glasgow Coma Scale: clinical application in Emergency Departments|volume=14|issue=8|pages=30–5|year=2006|doi=10.7748/en2006.12.14.8.30.c4221}} 6. ^{{cite web|url=https://www.cdc.gov/masstrauma/resources/gcs.pdf |title=Resources data |website=www.cdc.gov |format=PDF}} 7. ^{{cite journal |vauthors=Gill M, Windemuth R, Steele R, Green SM | title=A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes. | journal=Ann Emerg Med | year=2005 | volume=45 | issue=1| pages=37–42| doi= 10.1016/j.annemergmed.2004.07.429| pmid=15635308}} 8. ^{{cite journal | author = Green S. M. | year = 2011 | title = Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale | url = | journal = Annals of Emergency Medicine | volume = 58 | issue = 5| pages = 427–430 | doi = 10.1016/j.annemergmed.2011.06.009 | pmid=21803447}} 9. ^{{cite journal |pmid=19648386 |year=2009 |last1=Iver |first1=VN |last2=Mandrekar |first2=JN |last3=Danielson |first3=RD |last4=Zubkov |first4=AY |last5=Elmer |first5=JL |last6=Wijdicks |first6=EF |title=Validity of the FOUR score coma scale in the medical intensive care unit. |volume=84 |issue=8 |pages=694–701 |journal=Mayo Clinic Proceedings |doi=10.4065/84.8.694 |pmc=2719522}} 10. ^{{cite journal |pmc=2887186 |year=2010 |last1=Fischer |first1=M |last2=Rüegg |first2=S |last3=Czaplinski |first3=A |last4=Strohmeier |first4=M |last5=Lehmann |first5=A |last6=Tschan |first6=F |last7=Hunziker |first7=PR |last8=Marschcorresponding |first8=SC |title=Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study |volume=14 |issue=2 |pages=R-64 |journal=Critical Care |doi=10.1186/cc8963 |pmid=20398274}} Sources
8 : Emergency medicine|Intensive care medicine|Neuropsychological tests|Medical scales|Memory tests|Scottish inventions|Coma|Medical assessment and evaluation instruments |
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