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What scales are in use to quantify altered mental status?
The level of consciousness of a neurologically impaired patient may initially be evaluated by using a simple AVPU scale, representing four major levels of alertness: alert (A), responsive to verbal stimuli (V), responsive to painful stimuli (P), and unresponsive (U).
A more widely used measurement of consciousness is the Glasgow Coma Scale (GCS). Patients are graded on three areas of neurologic function: eye opening, motor responses, and verbal responsiveness. These numeric scores are added to determine the GCS score.
A GCS score of 3 is the minimum score possible and represents complete unresponsiveness, and a GCS score of 15 is assigned to fully alert patients. Details of the scores assigned are listed, for children above 2 years of age and below, in these tables
Glasgow Coma Scale
Score Value | Eye Opening | Best Motor Response | Best Verbal Response |
---|---|---|---|
6 | Obeys verbal command | ||
5 | Localizes to pain | Oriented, converses | |
4 | Spontaneous | Flexion withdrawal | Disoriented, converses |
3 | To speech | Flexion decorticate | Inappropriate words |
2 | To pain | Extension decerebrate | Incomprehensible sounds |
1 | None | None | None |
Pediatric Glasgow Coma Scale (Use for Patients under 2 Years of Age)
Score Value | Eye Opening | Best Motor Response | Best Verbal Response |
---|---|---|---|
6 | Normal spontaneous movement | ||
5 | Withdraws to touch | Coos, babbles | |
4 | Spontaneous | Withdraws to pain | Irritable, cries |
3 | To speech | Abnormal flexion | Cries to pain |
2 | To pain | Abnormal extension | Moans to pain |
1 | None | None | None |