Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma sc

1. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale Anesthesia 2004; 59(1): 34-37 Presented by Ri???

2. The Glasgow Coma Scale The GCS evaluates consciousness by scoring a response in three areas: eye opening, motor response and verbal performance. The application of the GCS requires skill to achieve consistency in scoring.

3. ACDU scale Alert Confused Drowsy Unresponsive

4. AVPU scale Alert Responds to Voice Responds to Pain Unresponsive

5. Method All patients in whom a GCS assessment was clinically required were eligible for inclusion in the study. Neurosurgical nurses on one ward, who were experienced in the application and recording of the GCS. No specific training was given in the application of either of the simpler scales. Staff were encouraged to use their own judgment.

6. Method To record the conscious level of their patients using the AVPU, ACDU and GCS scales in this order. Each group of three observations was recorded on a separate data sheet so that each assessment was treated as an isolated observation. The participating nurses were also asked to comment on which of the simpler scales they found easier to use in each situation (AVPU, ACDU or neither).

8. Results Over a 7-month period: 1000 records compared AVPU, ACDU and the GCS, while a further 20 compared ACDU and GCS alone.

12. Results While the median GCS of the Confused group and the responds to Voice group are the same, the interquartile range (25-75% of values) is narrower and higher in the Confused group. The median values of ACDU were more evenly distributed than AVPU.

14. Results The same ranked position was used to describe the GCS (Alert and Alert 388, responds to Voice and Confused 225, responds to Pain and Drowsy 34, Unresponsive and Unresponsive 67) in 71% (714/1000) of the observations where both AVPU and ACDU were recorded.

15. Results The question concerning which of the simpler scales was easier to use was answered in 736 data sets, 389 expressing a preference between AVPU and ACDU. The nurses preferred to describe conscious level using AVPU when the GCS was lower, while ACDU was preferred when the GCS was higher.

16. Discussion Nurse: a small number; on one ward; skilled in the use of GCS; relatively short time scale for data collection. Neurosurgical nurses vs general ward nurses: experience in assessing level of consciousness; both have had little exposure to AVPU and ACDU. Patients on neurosurgical wards vs patients on general wards: CNS cause; metabolic, hypoxic and perfusion related events.

17. Discussion All assessments were made in the same order ��AVPU, ACDU and then GCS. It is important to score GCS last to minimize the incidence of nurses assigning categories of the simpler scores to GCS values.

18. Discussion ACDU may be better for the simple ward assessment of seriously ill patients and should be considered as a screening tool for deterioration in conscious level. In retrospect, it would have been desirable to randomize the order in which AVPU and ACDU were scored to minimize potential bias between these measurements.