Glasgow Coma Scale
The reliability of the Glasgow Coma Scale: a systematic review.
The Glasgow Coma Scale (GCS), introduced in 1974, was the first grading scale to offer an objective assessment of the consciousness of patients. The assessment of motor, verbal and eye responses of the GCS characterizes the level of consciousness. The picture provided by these responses enables comparison both between patients and of changes in patients over time that crucially guides management. The three components can be scored separately or combined in a sum score, ranging from 3 to 15. The sum score was initially used in research, but later also in clinical settings, even though summation of the three components incurs loss of information. Both the GCS and the sum score are used in the intensive care unit (ICU) in a broad spectrum of patients with reduced level of consciousness and the sum score is integrated in several ICU classification systems. An approximately linear relationship exists between decreasing sum scores and increasing mortality in patients with traumatic brain injury (TBI), and the motor component is a strong predictor of poor outcome in moderate/severe TBI.
Reliable scoring is fundamental to the practical utility of the GCS. Conceptually, reliability is the degree to which an instrument is free from measurement error. It has an external component (i.e. inter-rater reliability) which assesses the same subjects by different raters, and an internal component (i.e. intra-rater and test–retest reliability), which reflects the degree to which the scale yields identical results on different occasions and over time, assuming stable conditions. Reliability is, however, not an inherent property of a test, but a characteristic of the scores obtained when applying the test. Estimates of reliability are influenced by test properties, rater characteristics, study settings, heterogeneity of subjects and how subjects are treated, e.g. by intubation and sedation. It is important to identify factors that are potentially modifiable in order to improve the applicability of the GCS.
The reliability of the GCS has been examined in many studies, using a variety of measures, but remains an area of some controversy. Various reports, specifically in the field of intensive care and emergency medicine, have criticized the GCS and questioned its general applicability. Many assumptions are, however, based on limited evidence and mainly reflect personal opinions. No comprehensive systematic review on the reliability of the GCS and the factors that affect its reliability has been conducted since 1996. The aim of this systematic review is to explore the reliability of the GCS and the sum score, to identify influencing factors and to formulate recommendations for optimizing its reliability.
http://bit.ly/1PK7wJp
sedation score 在 RICHMOND AGITATION SEDATION SCALE (RASS) AND ... 的推薦與評價
RICHMOND AGITATION SEDATION SCALE (RASS) AND NURSES. Yellow Pages Nursing. Yellow Pages Nursing. 33.1K subscribers. Join. Subscribe. ... <看更多>