Coma scales.

摘要

Assessment of consciousness level is crucial in the care of patients with acute brain damage. Yet, for a long time, how it should be done was debatable, with diverging views and an array of approaches. Many of these approaches contained imprecisely defined concepts such as "stupor" or "lethargy", and depended on subjective judgment.The resulting absence of a common language caused confusion in management. There was also a lack of consistent communication in scientific publications. An approach was needed that could be used in all patients with acute brain damage. A study by Teasdale and Jennet4 in 1974 seemed to fulfil most of the requirements. This scale, subsequently called the Glasgow Coma Scale (GCS), became the standard method for assessing consciousness level throughout the world. Since 1974, advances-such as scanning of the brain by CT or MRI, intensive management at the scene of an accident, and sophisticated monitoring to support neurocritical care-have changed the management of acute brain injury. As a result, the continuing validity of the GCS has been questioned. Alternatives, most of which are derived from the GCS, have been proposed. The latest example is by Eelco Wijdicks and colleagues.