Let's refresh GCS
I listened to a really interesting talk by Mark Wilson (a prehospitalist and neurosurgeon in London) about the utility of GCS and whether it is time for us to reconsider our use of GCS in daily practice.
The history and application of the Glasgow Coma Scale is well described here, and worth a look for those who need to brush up on their knowledge. There is no doubt that by describing the GCS in 1974, Teasdale and Jennett made an amazing breakthrough in medical (neuro) science. They have managed to convert the multifaceted human brain functionality into a linear scale.
The GCS was initially intended for the assessment of coma and impaired consciousness in acute brain injury, but nowadays we are using it as a common language in many other situations - as an all cause mental status monitor. This is not necessarily wrong.
The GCS is now so fully ingrained in our practice, and we should not stop using it. I think we should be mindful of what it can't do, and perhaps consider some other forms of assessment to dive deeper into the complexity of human consciousness where needed. Adding the assessment of pupil response, ventilation and autonomic functions may just help. I am sure we do this subconsciously on many occasions already.
There is help out there - in the form of the FOUR score. (Full Outline of UnResponsiveness)
At the very least, when assessing conscious levels - describe what you see, use the GCS, document the pupil response and perhaps consider a more detailed examination using the principles of the FOUR score where indicated (not all patients!)
Mark wilson smacc talk
The Glasgow coma scale
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