GCS scoring question

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The GCS is a score for non-intubated non-paralysed non-sedated patients.
Once you put the tube in and give medication that change the level of
consciousness you CAN NOT use the CGS.  It was invented (I think by Teasdale
and Jannet in Scotland, before patients were intubated in the pre-hospital
setup - 1974???).  

If you want to insert the GCS data to the Trauma Registry, you have to find
out what was the best GCS measured BEFORE the medical personnel gave drugs
or inserted a tube.  That is not always simple and that is why there is NO
GCS value for trauma patients that come intubated and you can not retrieve
the information about the E V & M.  It also means you can't use the Ps
(probability of survival measure) provided as a calculation (that uses the
GCS) in some registries.

We give GCS measures (in the chart) to hospitalized patients that receive
sedatives and are sometimes ventilated just because it is convenient to use
it as a follow-up tool to monitor the alertness and motor function over
time. But it is not a REAL GCS as Karim says.  If we use it, we have to
mention if they are sedated or paralysed for ventilatory or other purposes
(GCS+T, GCS+TS, GCS+TSP).  However, Karim is right these measures are not
true GCS that you can use in the trauma registries.  There were many
attempts in the literature to develop other scoring scales without the
Verbal component.  Some of them were adopted by some registry softwares but
non are worldwide accepted as the good old GCS.

Mickey

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Karim Brohi
Sent: Thursday, September 06, 2007 12:20 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: GCS scoring question

3...
Or 2T
The purpose of the T is to declare that you cannot score the V component due
to intubation.
Therefore GCS is E1VTM1 and so 2T.
3T is bogus and scores the V component twice.
Trying to do a GCS on a paralyzed patient is more bogus.

But then again, Applying the GCS system to anything beyond the initial
evaluation is stretching the scale beyond its validation and is used as an
excuse for failing to describe the complete neurology.

Screwing with the GCS because a stupid registry doesn't accept non-numbers
or a blank is double bogus!!

:-)

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Simon
Sent: 05 September 2007 19:37
To: Trauma & Critical Care mailing list
Subject: GCS scoring question

Just a quick question for the group.
What is the GCS of this patient:
No spont eye opening
No movt to deep pain
Intubated
Is it 3, 3T or 2T?
Thanks
ron simon

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