| ARCHETYPE ID | openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1 |
| Concept | Glasgow Coma Scale (GCS) |
| Description | Fifteen point scale used to assess impairment of consciousness in response to defined stimuli. |
| Use | Use to record clinical responses of an adult to defined stimuli as an objective assessment of the level of consciousness. 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. |
| Misuse | Not to be used for assessing infants and young children - use OBSERVATION.glasgow_coma_scale_paediatric for this purpose to ensure that the eye, motor and verbal response choices are appropriate for the age and ability of the child. |
| Purpose | To record clinical responses of an adult to defined stimuli as an objective assessment of the level of consciousness. |
| References | 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. 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 (no longer available). Teasdale G. Glasgow Coma Scale: The Glasgow structured approach to Assessment of the Glasgow Coma Scale [Internet]. Sir Graham Teasdale; 2014 [accessed 2019 Oct 08]. Available from: http://www.glasgowcomascale.org/ and http://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid.pdf. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. doi: 10.1016/s0140-6736(74)91639-0. PubMed PMID: 4136544. Teasdale GM, Murray L. Revisiting the Glasgow Coma Scale and Coma Score. Intensive Care Med. 2000 Feb;26(2):153-4. doi: 10.1007/s001340050037. PubMed PMID: 10784300. V3 DCModels R1 I1 2010 Sep - Glasgow Coma Scale v0.75 [Internet]. Health Level Seven International. Published Jan 2014 [accessed 2019 Oct 08]. Available at: https://github.com/DetailedClinicalModels/Detailed-Clinical-Models/blob/master/Glasgow%20Coma%20Scale%20(GCS)/org.hl7.GlasgowComaScale(15pointversion)English-v0.75.pdf. |
| Copyright | © openEHR Foundation |
| Authors | Author name: Heather Leslie Organisation: Atomica Informatics Email: heather.leslie@atomicainformatics.com Date originally authored: 2007-03-13 |
| Other Details Language | Author name: Heather Leslie Organisation: Atomica Informatics Email: heather.leslie@atomicainformatics.com Date originally authored: 2007-03-13 |
| OtherDetails Language Independent | {licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=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. 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 (no longer available). Teasdale G. Glasgow Coma Scale: The Glasgow structured approach to Assessment of the Glasgow Coma Scale [Internet]. Sir Graham Teasdale; 2014 [accessed 2019 Oct 08]. Available from: http://www.glasgowcomascale.org/ and http://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid.pdf. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. doi: 10.1016/s0140-6736(74)91639-0. PubMed PMID: 4136544. Teasdale GM, Murray L. Revisiting the Glasgow Coma Scale and Coma Score. Intensive Care Med. 2000 Feb;26(2):153-4. doi: 10.1007/s001340050037. PubMed PMID: 10784300. V3 DCModels R1 I1 2010 Sep - Glasgow Coma Scale v0.75 [Internet]. Health Level Seven International. Published Jan 2014 [accessed 2019 Oct 08]. Available at: https://github.com/DetailedClinicalModels/Detailed-Clinical-Models/blob/master/Glasgow%20Coma%20Scale%20(GCS)/org.hl7.GlasgowComaScale(15pointversion)English-v0.75.pdf., current_contact=Heather Leslie, Atomica Informatics, heather.leslie@atomicainformatics.com, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=6C9DE7307EE72E4041258332EA705382, build_uid=661d7a86-424d-403e-8040-d2db2d8bee42, revision=1.2.0} |
| Keywords | response, motor, verbal, eye, stimulus, glasgow, coma, scale, neurological, responsiveness, EMV, conscious, GCS, trauma, central nervous system, consciousness |
| Lifecycle | published |
| UID | 2b50f15c-f3c9-473b-8e9c-f57c00507561 |
| Language used | en |
| Citeable Identifier | 1013.1.137 |
| Revision Number | 1.2.0 |
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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:
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:
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:
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