 | This article needs more medical references for verification or relies too heavily on primary sources .(October 2018) |  |
| Coma scale | |
|---|---|
| Purpose | determine severity of coma |
A coma scale is a system to assess the severity of coma. There are several such systems:
The Glasgow Coma Scale is neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale). GCS was initially used to assess level of consciousness after head injury and the scale is now used by first aid, EMS and doctors as being applicable to all acute medical and trauma patients. In hospital it is also used in chronic patient monitoring, in for instance, intensive care.
The Pediatric Glasgow Coma Scale (also known as Pediatric Glasgow Coma Score or simply PGCS) is the equivalent of the Glasgow Coma Scale (GCS) used to assess the mental state of adult patients. As many of the assessments for an adult patient would not be appropriate for infants, the scale was modified slightly. As with the GCS, the PGCS comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible PGCS (the sum) is 3 (deep coma or death) whilst the highest is 15 (fully awake and aware person).
The Blantyre Coma Scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children.
It was designed by doctors Terrie Taylor and Malcolm Molyneux in 1987, and named for the Malawian city of Blantyre, site of the Blantyre Malaria Project.
The Rancho Los Amigos Scale is used to assess individuals after a closed head injury based on cognitive and behavioural presentations as they emerge from coma. It is named after the Rancho Los Amigos National Rehabilitation Center, located in Downey, California, United States.
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
The Paediatric Glasgow Coma Scale or the Pediatric Glasgow Coma Score or simply PGCS is the equivalent of the Glasgow Coma Scale (GCS) used to assess the level of consciousness of child patients. As many of the assessments for an adult patient would not be appropriate for infants, the Glasgow Coma Scale was modified slightly to form the PGCS. As with the GCS, the PGCS comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible PGCS is 3 whilst the highest is 15. The pediatric GCS is commonly used in emergency medical services.
The AVPU scale is a system by which a health care professional can measure and record a patient's level of consciousness. It is mostly used in emergency medicine protocols, and within first aid.
There are several scoring systems in intensive care units (ICUs) today.
The Revised Trauma Score (RTS) is a physiologic scoring system, designed for use in based on the initial vital signs of a patient. A lower score indicates a higher severity of injury.
Rancho Los Amigos National Rehabilitation Center is a rehabilitation hospital located in Downey, California, United States. Its name in Spanish means 'Friends' Ranch'.
The Rancho Los Amigos Scale (RLAS), a.k.a. the Rancho Los Amigos Levels of Cognitive Functioning Scale (LOCF) or Rancho Scale, is a medical scale used to assess individuals after a closed head injury, including traumatic brain injury, based on cognitive and behavioural presentations as they emerge from coma. It is named after the Rancho Los Amigos National Rehabilitation Center, located in Downey, California, United States in Los Angeles County.
The Blantyre coma scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children.
Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.
An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty. People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. Those who are not able to be aroused from a sleep-like state are said to be stuporous. Coma is the inability to make any purposeful response. Scales such as the Glasgow coma scale have been designed to measure the level of consciousness.
Trauma in children, also known as pediatric trauma, refers to a traumatic injury that happens to an infant, child or adolescent. Because of anatomical and physiological differences between children and adults the care and management of this population differs.
Disorders of consciousness are medical conditions that inhibit consciousness. Some define disorders of consciousness as any change from complete self-awareness to inhibited or absent self-awareness and arousal. This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe but rare chronic coma. Differential diagnosis of these disorders is an active area of biomedical research. Finally, brain death results in an irreversible disruption of consciousness. While other conditions may cause a moderate deterioration or transient interruption of consciousness, they are not included in this category.
The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the Mayo Clinic in Rochester, Minnesota.
Pain stimulus is a technique used by medical personnel for assessing the consciousness level of a person who is not responding to normal interaction, voice commands or gentle physical stimuli. It forms one part of a number of neurological assessments, including the first aid based AVPU scale and the more medically based Glasgow Coma Scale.
The Wechsler Test of Adult Reading (WTAR) is a neuropsychological assessment tool used to provide a measure of premorbid intelligence, the degree of Intellectual function prior to the onset of illness or disease.
The Disability Rating Scale (DRS) was developed as a way to track a traumatic brain injury (TBI) patient from ‘Coma to Community’. The scale was used to rate the effects of injury and decide how long recovery might take. The rating gives insight into the cognitive impairment of the individual who suffered from the TBI.
The Galveston Orientation and Amnesia Test (GOAT) is a measure of attention and orientation, especially to see if a patient has recovered from post-traumatic amnesia (PTA) after a traumatic brain injury. This was the first measure created to test post-traumatic amnesia, and is still the most widely used test. The test was created by Harvey S. Levin and colleagues (1979), and features ten questions that assess temporal and spatial orientation, biographical recall, and memory. Points are awarded for responses to each question, with a 100 points possible. A score greater than 78 for three consecutive days is considered the threshold for emergence from post-traumatic amnesia. This test is intended for patients aged 15 years or older. Younger patients are given a modified version of the test, known as the Children's Orientation and Attention Test (COAT).
The Westmead Post-traumatic Amnesia Scale (WPTAS) is a brief bedside standardised test that measures length of post-traumatic amnesia (PTA) in people with traumatic brain injury. It consists of twelve questions that assess orientation to person, place and time, and ability to consistently retain new information from one day to another. It is administered once a day, each and every day, until the patient achieves a perfect score across three consecutive days, after which the individual is deemed to have emerged from post-traumatic amnesia. PTA may be deemed to be over on the first day of a recall of 12 for those who have been in PTA for greater than four weeks. The WPTAS is the most common post-traumatic amnesia scale used in Australia and New Zealand.
Sir Graham Michael Teasdale is an English neurosurgeon and the co-developer of the neurologic assessment tool known as the Glasgow Coma Scale. He is an Honorary Professor in Mental Health and Wellbeing in the Institute of Health and Wellbeing at the University of Glasgow Medical School.