MEDICAL >> ACUTE

Consciousness Scales employed in the acute Setting

Glasgow Coma Scale

Download scale (English)
Download scale (Chinese)
Background

Glasgow Liège Scale

Download scale (English)
Download scale (Chinese)
Background

Full Outline of UnResponsiveness

Download scale in English version

Download scale in French version

Wijdicks et al. (2005) have recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS, Teasdale and Jennett 1974) in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care)... [READ MORE]

Reaction Level Scale

Download scale
Background

The Reaction Level Scale (RLS85) was developed in Sweden in 1985 as an eight-grade scale for the assessment of patients in the ICU (Starmark et al. 1988). Its numeric values are not necessarily separated by steps of equal value. The information content of the GCS and the RLS85 is similar, though their construction differs (Table 1). By combining eye, verbal, and motor responses into a single-line ordinal scale it has a better discriminatory ability, greater accuracy and higher inter-observer agreement than the GCS (Segatore and Way 1992) and can be applied to patients who are intubated or whose eyes are swollen shut. There is a high correlation between the two scales, indicating a similar ranking order of neurologic defect severity. The Swedish Societies of Intensive Care, Anesthesiology and Neurosurgery have recommended replacement of the GCS with the RLS85 in that country’s hospitals.

Segatore, M. and C. Way (1992). "The Glasgow Coma Scale: time for change." Heart Lung 21(6): 548-57.
Starmark, J. E., D. Stalhammar, E. Holmgren and B. Rosander (1988). "A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85)." J Neurosurg 69(5): 699-706.

 

Innsbruck Coma Scale

Download scale
Background

The Innsbruck Coma Scale (ICS), also developed for assessment of victims of trauma, was published in 1991 (Benzer et al. 1991). The total score is analogous to that of the GCS in having a number of separate assessments that are scored separately but can be added for an aggregate score. Its eight items allow for a maximal score of 23. It is similar to the GCS, but excludes verbal response and contains pupillary size and reaction, movement and position of the eyes and oral automatisms. An anomaly is that the score rates dilated fixed pupils of greater severity (lower score) than midposition nonreactive pupils (De'Clari 1991). Thus, a patient with brain death (where midposition pupils are generally the rule) would achieve a better score than one who is not brain dead.

Benzer, A., G. Mitterschiffthaler, M. Marosi, G. Luef, F. Puhringer, K. De La Renotiere, H. Lehner and E. Schmutzhard (1991). "Prediction of non-survival after trauma: Innsbruck Coma Scale." Lancet 338(8773): 977-8.
De'Clari, F. (1991). "Innsbruck coma scale." Lancet 338(8781): 1537.

Edinburgh-2 Coma Scale

Download scale
Background

The Edinburgh-2 Coma Scale (E2CS) is a single-line scoring system (Sugiura et al. 1983). The best response is the one that is used in tabulating the score which is inversely related to consciousness. Its disadvantage is that it cannot be applied to patients who are unable to give an oral response.

Sugiura, K., K. Muraoka, T. Chishiki and M. Baba (1983). "The Edinburgh-2 coma scale: a new scale for assessing impaired consciousness." Neurosurgery 12(4): 411-5.

 

Clinical Neurologic Assessment Tool

Coma scale that includes brainstem indicators but has never convinced the medical community.

Crosby, L. and L. C. Parsons (1989). "Clinical neurologic assessment tool: development and testing of an instrument to index neurologic status." Heart Lung 18(2): 121-9.

Maryland Coma Scale

Coma scale that includes brainstem indicators but has never convinced the medical community.

Salcman, M., R. S. Schepp and T. B. Ducker (1981). "Calculated recovery rates in severe head trauma." Neurosurgery 8(3): 301-8.

Bouzarth Coma Scale

Neurosurgical watch sheet designed for craniocerebral trauma, includes brainstem reflexes. Old coma scale with no or very few users.

Bouzarth, W. F. (1968). "Neurosurgical watch sheet for craniocerebral trauma." J Trauma 8(1): 29-31.