Ми қабілетін бағалау шкаласы: Глазго кома шкаласы

Neurological scale for recording the conscious state of a person

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 behaviours 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 (such as a car accident) and also to monitor hospitalised 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.

During the 1960s, assessment and management of head injuries became a topic of interest. The number of head injuries was rapidly increasing, in part because of increased use of motorised transport. Also, doctors recognised that after head trauma, many patients had poor recovery. This led to a concern that patients were not being assessed or medically managed correctly. Appropriate assessment is a critical step in medical management for several reasons. First, a reliable assessment allows doctors to provide the appropriate treatment. Second, assessments let doctors keep track of how a patient is doing, and intervene if the patient is doing worse. Finally, a system of assessment allows researchers to define categories of patients. This makes it possible to determine which treatments are best for different types of patients. A number of assessments for head injury ("coma scales") were developed, though none were widely adopted. Of 13 scales that had been published by 1974, all involved linear scales that defined levels of consciousness. These scales posed two problems. First, levels of consciousness in these scales were often poorly defined. This made it difficult for doctors and nurses to evaluate head injury patients. Second, different scales used overlapping and obscure terms that made communication difficult.

In this setting, Bryan Jennett and Graham Teasdale of the University of Glasgow Medical School began work on what became the Glasgow Coma Scale. Based on their experiences, they aimed to make a scale satisfying several criteria. First, it needed to be simple, so that it could be performed without special training. Second, it needed to be reliable, so that doctors could be confident in the results of the scale. Third, the scale needed to provide important information for managing a patient with a head injury. This was because trained personnel could reliably distinguish flexion movements. Further research also demonstrated that normal and abnormal flexion have different clinical outcomes. As a result, the six point motor scale is now considered the standard. Teasdale did not originally intend to use the sum score of the GCS components. True widespread adoption of the GCS was attributed to two events in 1978. Second, the GCS was included in the first version of Advanced Trauma Life Support (ATLS), which expanded the number of centres where staff were trained in performing the GCS.

The GCS has come under pressure from some researchers who take issue with the scale's poor inter rater reliability and lack of prognostic utility. Although there is no agreed upon alternative, newer scores such as the simplified motor scale and FOUR score have also been developed as improvements to the GCS. Although the inter rater reliability of these newer scores has been slightly higher than that of the GCS, they have not yet gained consensus as replacements.