Coma scales: a historical review

Abstract

Objective: To describe the most important coma scales developed in the last fifty years. Method: A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. Results: Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. Discussion: Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

Sensitivity and Specificity of Full Outline of Unresponsiveness Score and Glasgow Coma Scale towards Patients’ Outcomes at the Intensive Care Units

“…4 Glasgow Coma Scale (GCS) is an instrument which is broadly used to discover the level of brain injury and the level of coma of a patient with head injury. 5 The GCS instrument has been tested for its validity and reliability which result was good and it has good correlation on the result of patients' outcome in forms of the number of mortality in Intensive Care Unit. 6,7 This GCS instrument is simple, practical, standardized, has three assessment components including eyes response, verbal response, and motoric response in which each component has different score.…”

Men and motorcycle accidents: severity of casualties from the prehospital care

“…These indexes are scoring systems designed to assess the physiological changes, severity of anatomic injuries and the probability of survival of injured patients. 20 SAMU-ES uses the ECG to establish the neurological condition of the victim. This scale allows, in addition to infer about neurological conditions, survival probability forecast and sequelae of victim.…”

“…This scale allows, in addition to infer about neurological conditions, survival probability forecast and sequelae of victim. 10,20 The value of ECG and systolic blood pressure and respiratory rate allows the rescuer, after a simple score, in estimating the severity of the victim at the accident site through the Revised Trauma Score (RTS).…”

“…Another severity index, called Injury Severity Score (ISS), 20 classified as anatomical by taking into account the injuries in the various segments of the body, can also be used, however the severity of anatomic lesions is determined by physical examination, radiological tests, surgery and autopsy, obviously it is not possible implementation in the pre-hospital care.…”

Penilaian Kesadaran pada Anak Sakit Kritis: Glasgow Coma Scale atau Full Outline of UnResponsiveness score?

“…Penilaian kesadaran merupakan keterampilan klinis yang harus dipunyai seorang dokter, walaupun definisi yang tepat untuk mendeskripsikan setiap tingkat kesadaran sulit untuk ditetapkan. 1 Skala koma yang ideal seharusnya bersifat linear (mempunyai bobot yang sama bagi setiap komponen), reliabel (mengukur yang seharusnya diukur), valid (menghasilkan nilai yang sama pada pemeriksaan berulang), dan mudah digunakan (memiliki instruksi yang sederhana tanpa memerlukan alat bantu atau kartu). Skala ini seharusnya dapat juga memprediksi luaran walaupun angka kematian di ruang rawat intensif dapat dipengaruhi oleh berbagai faktor lain yang mempengaruhi.…”