ARCHETYPE Paediatric Glasgow Coma Scale (pGCS) (openEHR-EHR-OBSERVATION.glasgow_coma_scale_paediatric.v0)

ARCHETYPE IDopenEHR-EHR-OBSERVATION.glasgow_coma_scale_paediatric.v0
ConceptPaediatric Glasgow Coma Scale (pGCS)
DescriptionFifteen point scale used to assess impairment of consciousness in response to defined stimuli in a child or infant.
UseUse to record clinical responses of the child or infant to defined stimuli as an objective assessment of the level of consciousness that is also appropriate for age and ability. 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 adults - use OBSERVATION.glasgow_coma_scale for this purpose.
PurposeTo record clinical responses of the child or infant to defined stimuli as an objective assessment of the level of consciousness that is also appropriate for age and ability.
ReferencesCrippen 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
AuthorsAuthor name: Heather Leslie
Organisation: Atomica Informatics
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2007-03-13
Other Details LanguageAuthor 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 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., 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=1E756A5BC4064903D1E2066C1FCBD663, build_uid=5da99e4a-b0ec-4e87-b340-c83942fb65d2, revision=0.0.1-alpha}
Keywordsresponse, motor, verbal, eye, stimulus, glasgow, coma, scale, neurological, responsiveness, EMV, conscious, GCS, trauma, central nervous system, consciousness
Lifecyclein_development
UIDc4e66393-fa68-4976-b106-4c26f870e465
Language useden
Citeable Identifier1013.1.4188
Revision Number0.0.1-alpha
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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=, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={identities=[], other_participations=[], credentials=[], description=[], relationships=[], ism_transition=[], activities=[], items=[], 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 response to any stimulus and no interfering factors. For example: eyes physically closed due to local swelling.]
2: To pain [Eyes opening in response to pain only.]
3: To sound [Eyes opening after verbal stimuli. Not to be confused with wakening of a sleeping person.]
4: Spontaneous [Eyes open before stimulus.]


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, 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 verbal response and no interfering factor. For example: intubation or profound deafness.]
2: Child: Sounds OR Infant: Moans in response to pain [Child makes incomprehensible words or non-specific sounds; Infant moans in response to pain.]
3: Child: Words OR Infant: Cries in response to pain [Child makes intelligible single words; Infant cries in response to pain.]
4: Child: Confused OR Infant: Irritable cries [Child is not orientated but communicates; Infant cries irritably.]
5: Child: Orientated OR Infant: Coos and babbles [Child oriented and appropriate; Infant coos or babbles as normal.]


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 and no interfering factor. For example: paralysis.]
2: Abnormal extension [Decerebrate extension of arms and/or legs in response to stimuli. For example: extending 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 [Withdraws in response to pain. For example: flexion of wrist when supra-orbital pressure applied; pulls part of body away when nailbed pinched.]
5: Localising [Withdraws to touch. For example: brings hand above the clavicle when supra-orbital pressure is applied.]
6: Child: obeys commands OR Infant: Moves spontaneously and purposefully [Child follows verbal request for movement; Infant moves as expected.]


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