Comparison of Neurological Assessment Tools Gcs Avpu and Four

An assessment of the level of consciousness (LOC) should be carried out during the primary survey of all patients, using the ABCDE approach Cole (2009: 28). Any initial or subsequent reduction in the LOC of the patient may be caused by hypoxia; hypovolaemia; head injury; drug or medicine use; hypoglycaemia; hypothermia or alcohol ingestion (Cole, 2009:44).

An assessment of the LOC of the patient is vital for an accurate pain assessment and the administration of analgesia, and the subsequent assessment of its efficacy (Rose, et al. 2011). Regular evaluation of a patient’s LOC helps detect the onset of hypothermia and hypovolaemia. Muehlberger, et al. (2010) state that the development of pre-hospital hypothermia is a directly negative prognostic factor for burns patients.

The inclusion of LOC assessment for burns patients seems to be a recent development however, neither Allison & Porter (2004) nor Allison (2002) refer in any way to assessing a patient’s LOC in their work on standardising a pre-hospital approach to burns patient management.

A coma scale is a defined methodology by which neurological observations can be recorded in a standardised way by clinicians (Coyne, et al. 2010). Many different scales have been developed in an attempt to standardise the assessment of consciousness (Majerus, 2005).

In this essay I will discuss three main coma scales and examine their strengths and weaknesses. I will also briefly discuss a number of revisions to these scales.

Glasgow coma scale (GCS) and variations

The GCS is the most commonly used coma scale in the acute setting (Majerus, 2005) and its use is recommended by the National Institute for Health and Clinical Excellence (NICE, 2007). The scale was devised by Teasdale & Jennett based on their work in the neurosurgery department at the University of Glasgow. Their scale allows a clinician with minimal training to perform three basic assessments measuring the eye, verbal and motor

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