The document summarizes the Glasgow Coma Scale (GCS), a tool used to assess impairment of consciousness. It describes the origins and components of the GCS and discusses developments like the Glasgow Coma Scale-Pupils score (GCS-P), which combines GCS and pupil reactivity, and the GCS-Pupils Age (GCS-PA) charts and GCS-PA-CT charts, which incorporate age and CT scan findings to improve prognostic accuracy. The document outlines strategies to standardize GCS assessment and limitations but emphasizes the scale's importance in clinical practice and research worldwide.
The GCS is an important assessment tool that provides a common language for communication between multi-disciplinary groups
GCS is applicable for paediatrics as well as adults
The GCS is an important assessment tool that provides a common language for communication between multi-disciplinary groups
GCS is applicable for paediatrics as well as adults
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent 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 (more widely used modified or revised scale).
The GCS assess a persons based on their ability to perform eye movements,, speak, and move their body. These three behaviors make up the three elements of scale: eye, verbal,& motor. A persons GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score used to guide immediate medical care after a brain injury (such as car accident) and also to monitor hospitalized patients and track their level of consciousness.
The Glasgow coma scale was first published in 1974 at the university of Glasgow by neurosurgery professors Graham Teasdale & Bryan Jennett. The Glasgow coma scale is used to objectively describe the extent of impaired consciousness in all type of acute medical and trauma patients.
The Glasgow coma scale (GCS) is a clinical scale used to reliably measure a persons level of consciousness after a brain injury.
Or
The GCS is the summation of scores for eye, verbal, & motor responses. The minimum score is 3 which indicates deep coma or a brain dead state. The maximum is 15 which indicates a fully awake patients.
It's a presentation on GCS 2023.
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent 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 (more widely used modified or revised scale).
The GCS assess a persons based on their ability to perform eye movements,, speak, and move their body. These three behaviors make up the three elements of scale: eye, verbal,& motor. A persons GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score used to guide immediate medical care after a brain injury (such as car accident) and also to monitor hospitalized patients and track their level of consciousness.
The Glasgow coma scale was first published in 1974 at the university of Glasgow by neurosurgery professors Graham Teasdale & Bryan Jennett. The Glasgow coma scale is used to objectively describe the extent of impaired consciousness in all type of acute medical and trauma patients.
The Glasgow coma scale (GCS) is a clinical scale used to reliably measure a persons level of consciousness after a brain injury.
Or
The GCS is the summation of scores for eye, verbal, & motor responses. The minimum score is 3 which indicates deep coma or a brain dead state. The maximum is 15 which indicates a fully awake patients.
It's a presentation on GCS 2023.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
The GCS assesses a person based on their ability to perform eye movements, speak, and move their body.
These three behaviors make up the three elements of the scale: eye, verbal, and motor.
A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury and also to monitor hospitalized patients and track their level of consciousness.
Lower GCS scores are correlated with higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual person with brain injury.
The Glasgow Coma Scale is used for people above the age of two and composed of three tests: eye, verbal, and motor responses.
It's a presentation on GCS 2023.
The role of emotional factors in glaucoma has received wide recognition by investigators and clinicians from the very beginning. Prevalence of depression in glaucoma has been estimated to be 10 to 12 percent in previous studies. Insomnia is another psychiatric co-morbidity reported with glaucoma. Both depression and insomnia in glaucoma patients may significantly affect overall quality of life in these patients adversely. The present study explores the predictive factors of insomnia and depression in patients with Glaucoma. A case-series type of observational study was carried out on 100 glaucoma cases attended at ESIC Model Hospital, Jaipur (Rajasthan) India. The PHQ -9 and ISI were used to assess depression and insomnia respectively. Data in details were collected as per pre-designed Performa. Data collected were analyzed and inferred with chi-square test. Insomnia and depression was found in 37% and 36% respectively in glaucoma cases. Insomnia and depression both were found associated with Age, Visual acuity in both the eyes and severity of glaucoma. No other studied socio-demographic and disease variables had significant association with either insomnia or depression. It was concluded that insomnia and depression are commonly found with glaucoma. Both insomnia and depression were found significantly more in older agr group, less visual acuity and sever glaucoma than their counterparts.
Identifying Significant Antipsychotic-Related Side Effects in Patients on a Community Psychiatric Rehabilitation Unit-A Feasibility Study of The Glasgow Antipsychotic Side-Effect Scale (GASS) by Ahmed Saeed Yahya* in crimson publishers: Journal of Physical Medicine and Rehabilitation
Antipsychotic side-effects are common and are an important determinant of non-adherence and consequent relapse. Most rating scales for the identification of these are lengthy and complicated. This report reviews the medical literature on the Glasgow antipsychotic side-effect scale (GASS)-a brief and validated rating scale to measure the unwanted effects of antipsychotics. We administered the GASS to fourteen in-patients in a United Kingdom-based Community Psychiatric Rehabilitation Unit. The objective was to establish the utility of the GASS in this setting and to make recommendations on how this tool could be used in clinical practice to improve adherence to antipsychotic medication.
https://crimsonpublishers.com/epmr/fulltext/EPMR.000529.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Examines in Physical Medicine & Rehabilitation
Please click on: https://crimsonpublishers.com/epmr/
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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1. Glasgow Coma Scale
What is new?
Dr.Venugopalan P P
Director and Lead consultant in
Emergency Medicine
Aster DM Healthcare
2. What is GCS?
The Glasgow Coma Scale provides a practical
method for assessment of impairment of
conscious level in response to defined stimuli.
3. “The Glasgow Coma Scale is an
integral part of clinical practice and
research across the World. The
experience gained since it was first
described in 1974 has advanced the
assessment of the Scale through the
development of a modern structured
approach with improved accuracy,
reliability, and communication in its
use.”
Sir Graham Teasdale
Emeritus Professor of Neurosurgery
University of Glasgow
4. When looking back...
● The Scale was described in 1974
● Graham Teasdale and Bryan Jennett
● Way to communicate about the level of consciousness of
patients with an acute brain injury.
Assessment of coma and impaired consciousness. A practical scale.
Lancet 1974; 2:81-4
25. Confounding factors rendering one or more components
of the Glasgow Coma Scale untestable
○ Drugs (anaesthetics, sedatives,
neuromuscular blockade, etc)
○ Cranial nerve injuries
○ Intoxication (alcohol or drugs)
○ Hearing impairment
○ Intubation or tracheostomy
Use NT
whenever
such
factors are
existing
26. Confounding factors rendering one or more components
of the Glasgow Coma Scale Untestable
○ Limb or spinal-cord injuries
○ Dysphasia
○ Pre-existing disorders (dementia
or psychiatric disorders)
○ Ocular trauma
○ Language and culture
○ Orbital swelling
Use NT
whenever
such
factors are
existing
32. Prevention and management of missing components
● Avoid missing values
❖ Temporary stop sedation (wake-up test)
● Simple imputation (same value for each patient)
❖ Record the verbal scale in patients intubated or with
tracheostomy as VT(ube)
❖ We advise against assigning a score of 1 to eye and
verbal components in sedated or untestable patients
33. Prevention and management of missing components
● Statistical imputation (single or multiple
imputation) based on data
❖ Imputation of verbal score from eye and motor
components
❖ Imputation based on other patient
characteristics
34. Strategies to improve GCS
● Describe the responses of each of the
components in individual patients
● Use the extended six-point motor subscale
and 15-point score
● Do not assign 1 for imputation of missing
values
● Chart and display changes over time
35. Strategies to improve GCS
● Limit the use of the score to classification and research
● Improve standardisation in assessment of patients
● Develop training instruments and implement quality
improvement programmes
● Use the scale for prognosis only in combination with other
prognostic factors (eg, Age, Pupil reactivity, and
Imaging)
38. GCS P
The GCS Pupils Score (GCS-P) was
described by Paul Brennan, Gordon
Murray and Graham Teasdale in 2018
as a strategy to combine the two key
indicators of the severity of traumatic brain
injury into a single simple index
39. How do I score GCS-P
● GCS-P is calculated by subtracting the Pupil Reactivity
Score (PRS) from the Glasgow Coma Scale (GCS) total
score
GCS-P = GCS minus PRS
GCS-P is Ranging from 15 to 1
41. Advantage of GCS P
● GCS and the pupil response to light are both related to
outcome
● Combining the information together in the GCS-P extends
the information provided about outcome to an extent
comparable to more complex methods of combination of
the data
● Improve decision making about patient care, and assist in
stratification of patients into clinical trials.
42. Advantage of GCS P
● GCS-P Score may also be a useful platform onto which
information about other key prognostic features can be
added in a simple format likely to be useful in clinical
practice
43. Evidence based exercise
In the first paper, Brennan, Murray, and Teasdale describe the
development of the Glasgow Coma Scale-Pupils score
(GCS-P), a simple but elegant tool that extends the
information collected by the GCS score on the severity of
TBI.
44. Evidence based exercise
The authors examined
1. Relationships between GCS scores and pupils’ reaction to
light
2. Relationships between these factors and patient outcome
6 months after injury
45. Evidence based exercise
They examined data from
● CRASH[1] and IMPACT[2]
● The two largest databases containing information on
individual patients with TBI
46. GCS P Case study
Imagine that you are asked to assess a patient who has been
ejected from the passenger seat of a car at high velocity.
They make no eye, verbal or motor movements
spontaneously, or in response to your spoken requests.
47. GCS P Case study
● When stimulated their eyes do not open
● Make only incomprehensible sounds
● Flex arms abnormally
● Scored as E1V2M3 using the Glasgow Coma
Scale
● Sum score of 6.
48. GCS P Case study
● Now test their pupil reactivity to light
● Neither pupil is reactive to light.
● Pupil Reactivity Score (PRS) of 2.
● GCS-P can then be determined as
GCS-PRS
● In this case it 6-2 =4.
49. GCS P Case study
● GCS 6 there is a 29% chance of death at 6
months
● When the pupil reactivity and GCS are
combined to give a GCSP, the mortality
increases to 39%
52. GCS -P
● Used as an index of ‘overall’ brain damage
● Distinguishing head injuries of differing
severities
● Monitoring their progress and prognosis
53. GCS -P
‘Brain stem’ features were not incorporated into the scale, but
were expected to be assessed separately
There have nevertheless been views that more complex
scores, with extra features would be useful.
56. GCS PA
● GCS Pupils Age prognostic charts
● Developed by Gordon Murray, Paul Brennan and Graham
Teasdale, and published by the Journal of Neurosurgery
in 2018
● The charts provide a simple graphical presentation of
the probabilities of outcome from traumatic brain
injury based on GCS, Pupil reactivity, Age and CT
scan findings.
57. GCS Pupils Age prognostic charts
● Four prognostic factors contain much of the
information about prognosis of people with an
acute head injury
● GCS, pupil reactivity to light, age, and the
findings on
● Computer Tomography (CT) scan are the
most useful investigative index
58. GCS Pupils Age prognostic charts
● Combining them to convey
information graphically
about risks of mortality, or
the prospects for
independent recovery,
after head injury.
1. GCS
2. Pupil
reactivity
3. Age
4. CT Scan
finding
59. GCS PA
● Observed the additive effect on outcome that occurs
when age is added to the patient’s admission GCS-P
● The risk of death after TBI increases as patient age
advances
● At all ages the risk of death increases as the GCS-P
decreases.
60. GCS - PA
● Probability of favourable outcome is greater in
younger patients and in patients with higher
GCS-P
61. GCS -PA Charts
● The authors created two prediction charts based on the
GCS-P and patient age stratified into 5-year increments
(GCS-PA charts)
● One chart clearly shows risks of death
● Other chart probabilities of favourable outcomes in
patients 6 months after TBI.
67. GCS P A plus CT findings
● CT findings are the other important predictor of patient
outcome
● CT scan findings showed the differences in outcome are
very similar between patients with or without either a
haematoma, or absent cisterns, or subarachnoid
haemorrhage
68. GCS P A plus CT findings
Taken in combination there is a gradation in risk with
increasing numbers of any of these abnormalities
A simple extension of the prognostic charts can then be made
by stratifying the original charts into three CT groupings:
● No
● Only One
● Two or more
CT Abnormalities
69. GCS-PA CT charts
● Simplify three different abnormal CT findings into scores
based solely on the number of abnormalities
● Created two sets of three predictive charts based on the
GCS-P plus patient age and number of CT abnormalities
(GCS-PA CT charts)
● Charts for No CT abnormalities ,Only one abnormalities &
Two or More abnormalities
70. GCS-PA CT charts
1. One chart follows probabilities of death 6 months after
injury
2. Other set follows probabilities of favourable outcome at
the same time point.
● Charts can be used by clinicians in decision making
● Communicating predictive information to other clinicians,
patients, and caregivers.
78. GCS-P- A - CT prognostic Tables
● Developed from data created by the IMPACT and
CRASH studies
● These studies include patients exhibiting a wide spectrum
of haematoma.
● The size of the haematoma or severity of subarachnoid
haemorrhage does not need to be separately considered
● Size and severity will influence the GCS and pupil
reactivity
80. Authors response on the studies
“Decisions about patient care in the immediate
aftermath of a head injury are influenced by
physician perceptions of the patient’s likely
outcome, so it’s important that assumptions that
underlie these decisions are correct.
81. Authors response on the studies
“Working together between Glasgow and
Edinburgh, we have developed the GCS-P and
associated prognostic charts. These simple and
easy to use tools provide reliable estimates of
outcomes at 6 months and will support clinician
decision making in neurotrauma.”