ARCHETYPE Glasgow coma scale (openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1)

ARCHETYPE IDopenEHR-EHR-OBSERVATION.glasgow_coma_scale.v1
ConceptGlasgow coma scale
DescriptionFifteen point scale used to assess impairment of consciousness in response to defined stimuli. More correctly known as the Modified Glasgow coma scale.
UseUse to record clinical responses of an adult subject of care to stimuli. It is commonly used to establish a baseline conscious state and neurological function assessment and/or to detect patients who may require immediate medical intervention. The Glasgow coma scale has three subscales E (eye), V (verbal) and M (motor). In clinical practice all three subscales are reported individually plus the 'Total score', if applicable. A recorded response for each of E, V and M is mandatory. If a response cannot be tested, then the 'Not Applicable' null flavour should be recorded; do not use the 'None' ordinal value to record a missing component. Details about the reason for not being able to test a response can be recorded in the 'Confounding factors' data element. The 'Total score' can be derived as the sum of the recorded eye, motor and verbal response scores. It is not appropriate to report a 'Total score' when one or more components are not testable because the score will be artificially low - in this situation record the EVM profile instead. The three response values are considered separately as well as their sum. The 'EVM profile' can be derived as a concatenation of each of the recorded eye, motor and verbal response scores. For example, E3 V4 M2 represents the conscious state of a subject who opens eyes to speech, utters incomprehensible sounds and has an extensor response to stimulation. The minimum possible 'Total score' value is 3 (equivalent to E1 V1 M1) and the maximum possible is 15 (equivalent to E4 V5 M6). In practical use, Glasgow coma scale is recorded as one component of clinical monitoring, using sequential and repeated point-in-time measurements. Date and time should be recorded for each measurement, as well as any factors that may influence interpretation of changes. Changes in 'Total score' or any E, V or M values may have as much clinical significance as the value recorded initially.
MisuseNot to be used for assessing infants and young children - an archetype for Paediatric Glasgow Coma Scale will be required to ensure that the eye, motor and verbal response choices are appropriate for the age and ability of the child.
PurposeTo record clinical responses of the subject of care to defined stimuli as an objective assessment of the level of consciousness.
ReferencesTeasdale G. Glasgow Coma Scale: The Glasgow structured approach to Assessment of the Glasgow Coma Scale [Internet]. Sir Graham Teasdale; 2014 {cited 2015 Apr 20]. Available from: http://www.glasgowcomascale.org/ and http://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid.pdf.

Glasgow Coma Scale, draft archetype, NEHTA Clinical Knowledge Manager [Internet]. Australia: National eHealth Transition Authority. Authored: 2007 Mar 13. Available at: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.1160 (accessed 2015 Mar 05).

Crippen DW. Head Trauma - Presentation: Medscape Reference: Drugs, Diseases & Procedures [Internet]. WebMD LLC: c1994-2013; [updated 2012 Jun 21; accessed 2015 Mar 05]. Available from: http://emedicine.medscape.com/article/433855-overview#a0112.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84.

Teasdale GM, Murray L. Revisiting the Glasgow Coma Scale and Coma Score. Intensive Care Medicine. 2000; 26: 153-154.

V3 DCModels R1 I1 2010 Sep - Glasgow Coma Scale v0.75 [Internet]. Health Level Seven International. Published Jan 2014. Available at: https://github.com/DetailedClinicalModels/Detailed-Clinical-Models/blob/master/Glasgow%20Coma%20Scale%20(GCS)/org.hl7.GlasgowComaScale(15pointversion)English-v0.75.pdf (accessed 22 Mar 2015)
Copyright© openEHR Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2007-03-13
Other Details LanguageAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2007-03-13
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=openEHR Foundation, references=Teasdale G. Glasgow Coma Scale: The Glasgow structured approach to Assessment of the Glasgow Coma Scale [Internet]. Sir Graham Teasdale; 2014 {cited 2015 Apr 20]. Available from: http://www.glasgowcomascale.org/ and http://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid.pdf. Glasgow Coma Scale, draft archetype, NEHTA Clinical Knowledge Manager [Internet]. Australia: National eHealth Transition Authority. Authored: 2007 Mar 13. Available at: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.1160 (accessed 2015 Mar 05). Crippen DW. Head Trauma - Presentation: Medscape Reference: Drugs, Diseases & Procedures [Internet]. WebMD LLC: c1994-2013; [updated 2012 Jun 21; accessed 2015 Mar 05]. Available from: http://emedicine.medscape.com/article/433855-overview#a0112. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. Teasdale GM, Murray L. Revisiting the Glasgow Coma Scale and Coma Score. Intensive Care Medicine. 2000; 26: 153-154. V3 DCModels R1 I1 2010 Sep - Glasgow Coma Scale v0.75 [Internet]. Health Level Seven International. Published Jan 2014. Available at: https://github.com/DetailedClinicalModels/Detailed-Clinical-Models/blob/master/Glasgow%20Coma%20Scale%20(GCS)/org.hl7.GlasgowComaScale(15pointversion)English-v0.75.pdf (accessed 22 Mar 2015), current_contact=Heather Leslie, Ocean Informatics, heather.leslie@oceaninformatics.com, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=83BD01BA1AEB3976DE633DCF0273E46E, build_uid=e5b605a5-bfd0-401a-8109-d0ce44e539aa, revision=1.1.0}
Keywordsresponse, motor, verbal, eye, stimulus, glasgow, coma, scale, neurological, responsiveness, EMV, conscious, GCS, trauma, central nervous system, consciousness
Lifecyclepublished
UID2b50f15c-f3c9-473b-8e9c-f57c00507561
Language useden
Citeable Identifier1013.1.137
Revision Number1.1.0
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Fifteen point scale used to assess impairment of consciousness in response to defined stimuli. More correctly known as the Modified Glasgow coma scale., archetypeConceptComment=null, otherContributors=Tomas Alme, DIPS, Norway
Nadim Anani, Karolinska Institutet, Sweden
Vebjoern Arntzen, Oslo university hospital, Norway
Koray Atalag, University of Auckland, New Zealand
Silje Ljosland Bakke, Bergen Hospital Trust, Norway
Lars Bitsch-Larsen, Haukeland University hospital, Norway
Martin Boeker, Medical Center - University of Freiburg, Germany
Marja Buur, Medisch Centrum Alkmaar/ Code24, Netherlands
Margaret Campbell, Queensland Health, Australia
Rong Chen, Cambio Healthcare Systems, Sweden
Stephen Chu, Queensland Health, Australia
Tamsin Cockayne, Australia
Marc Cotran, identity vision systems, Canada
Angela de Zwart, Orion Health, New Zealand
Einar Fosse, National Centre for Integrated Care and Telemedicine, Norway
Sebastian Garde, Ocean Informatics, Germany
Christian Ghan, The Chris O'Brien Lifehouse at RPA, Australia
William Goossen, Results 4 Care, Netherlands
Heather Grain, Llewelyn Grain Informatics, Australia
Birger Haarbrandt, Hannover Medical School, Germany
Sam Heard, Ocean Informatics, Australia
Oliver Hosking, Remote Health NT, Australia
Evelyn Hovenga, EJSH Consulting, Australia
Eugene Igras, IRIS Systems, Inc., Canada
Sundaresan Jagannathan, Scottish NHS, United Kingdom
Konstantinos Kalliamvakos, Cambio Healthcare Systems, Sweden
Lars Karlsen, DIPS ASA, Norway
Shinji Kobayashi, Kyoto University, Japan
Sergey Kovalenko, Chelyabinsk Regional Children Hospital, Russia
Heather Leslie, Ocean Informatics, Australia (Editor)
Hallvard Lærum, Oslo University Hospital, Norway
Luis Marco Ruiz, Norwegian Center for Integrated Care and Telemedicine, Norway
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (Editor)
Jeroen Meintjens, Medisch Centrum Alkmaar, Netherlands
Andrej Orel, Marand d.o.o., Slovenia
Michael Reynolds, Great Lakes Pediatric Associates, PLLC, United States
Hossein Riazi, Iran
Arturo Romero, SESCAM, Spain
Jussara Rotzsch, UNB, Brazil
Anoop Shah, University College London, United Kingdom
Tony Shannon, NHS, United Kingdom
Gary Sinclair, NT DoH, Australia
Tim Sturgill, United States
Soon Ghee Yap, Singapore General Hospital, Singapore, originalLanguage=en, translators=Swedish: Kirsi Poikela, Tieto Sweden Healthcare & Welfare AB, ext.kirsi.poikela@tieto.com
Norwegian Bokmål: John Tore Valand/Silje Ljosland Bakke, Helse Bergen HF/Nasjonal IKT HF
Spanish (Argentina): Alan March, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina, alandmarch@gmail.com
Portuguese (Brazil): Vladimir Pizzo, Hospital Sirio Libanes, Brazil, vladimir.pizzo@hsl.org.br
Arabic (Syria): Mona Saleh
, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={details=[], identities=[], source=[], credentials=[], context=[], description=[], ism_transition=[], events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002], code=at0002, itemType=EVENT, level=2, text=Any event, description=Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=EVENT, bindings=null, values=null, extendedValues=null]], content=[], items=[], capabilities=[], other_participations=[], contacts=[], target=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0009], code=at0009, itemType=ELEMENT, level=4, text=Best eye response (E), description=Best response of eyes to test stimulus., comment=Most commonly, the score for eye response will be selected from one of the ordinal values, however if a response cannot be tested, for example if the subject of care cannot physically open their eyes due to other injuries, then the "Not Applicable" null flavour should be recorded., uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: None [No eye opening at any time, no interfering factor. For example: eyes closed by local swelling.]
2: To pressure [Eyes opening after finger tip stimulus.]
3: To sound [Eyes opening after spoken or shouted request. Not to be confused with wakening of a sleeping person.]
4: Spontaneous [Eyes open before stimulus.]


Possible reasons why null:
  • not applicable
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0007], code=at0007, itemType=ELEMENT, level=4, text=Best verbal response (V), description=Best verbal response to test stimulus., comment=Most commonly, the score for verbal response will be selected from one of the ordinal values, however if a response cannot be tested, for example if the subject of care is intubated, then the "Not Applicable" null flavour should be recorded., uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: None [No audible response, no interfering factor. For example: intubation; profound deafness.]
2: Sounds [Only moans/groans.]
3: Words [Intelligible single words.]
4: Confused [Not orientated but communicates coherently.]
5: Orientated [Correctly gives name, place and date.]


Possible reasons why null:
  • not applicable
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0008], code=at0008, itemType=ELEMENT, level=4, text=Best motor response (M), description=Best motor response to test stimulus., comment=Most commonly, the score for motor response will be selected from one of the ordinal values, however if a response cannot be tested, for example if the subject of care cannot move their limbs due to injury or paralysis, then the "Not Applicable" null flavour should be recorded., uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: None [No movement in arms/legs, no interfering factor. For example: paralysed.]
2: Extension [Decerebrate extension of arms and/or legs in response to stimuli. For example: extends arm at elbow.]
3: Abnormal flexion [Slow, decorticate flexion of arms and/or legs. For example: bends arm at elbow, but features predominantly abnormal.]
4: Normal flexion [Rapid flexion in response to stimuli but features predominantly normal. For example: flexion of wrist when supra-orbital pressure applied; pulls part of body away when nailbed pinched.]
5: Localising [Purposeful flexion towards painful stimuli. For example: brings hand above the clavicle when supra-orbital pressure is applied.]
6: Obeys commands [Follows verbal request for movement.]


Possible reasons why null:
  • not applicable
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0026], code=at0026, itemType=ELEMENT, level=4, text=Total score, description=The sum of the ordinal scores recorded for each of the three component responses., comment=The Total Score may be derived as the sum of the three response data elements and, if so, should be validated by the clinical information system against the individual scores entered by the clinician to ensure there is no conflict or inconsistency. Do not report a total score when one or more components are not testable because the score will be artificially low - in this situation record the EVM profile., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=min: >=3; max: <=15

, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0030], code=at0030, itemType=ELEMENT, level=4, text=EVM profile, description=Alternative assessment to 'Total Score' where the Eye Verbal Motor profile is expressed as three discrete components., comment=The EMV Score may be automatically derived as a concatenation of the three response data elements and, if so, should be validated by the clinical information system against the individual scores entered by the clinician to ensure there is no conflict or inconsistency. The 'Not applicable' null flavour value should be recorded as 'NT', for 'not tested' as per http://www.glasgowcomascale.org/., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0037], code=at0037, itemType=ELEMENT, level=4, text=Comment, description=Additional narrative about the measurement of the scale not captured in other fields., comment=Record the reasons for inability to test in the 'Confounding factors' data element., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], relationships=[], state=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/state[at0040]/items[at0041], code=at0041, itemType=ELEMENT, level=4, text=Confounding factors, description=Narrative record of factors that may have contributed to the GCS scores., comment=For example: deafness; aphasia; language issues; use of sedatives; hypothermia; or paralysis, severe facial/eye swelling or tracheal intubation as reasons for inability to record any one of the ordinal E, V or M assessments., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0038]/items[at0039], code=at0039, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null]], activities=[], provider=[]}, topLevelItems={data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0002]/data[at0003], code=at0003, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..1, cardinalityText=mandatory, subCardinalityFormal=3..*, subCardinalityText=Minimum of 3 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], state=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0002]/state[at0040], code=at0040, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..1, cardinalityText=mandatory, subCardinalityFormal=0..*, subCardinalityText=Minimum of 0 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0038], code=at0038, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..1, cardinalityText=mandatory, subCardinalityFormal=0..*, subCardinalityText=Minimum of 0 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0038]/items[at0039], code=at0039, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]