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Sat Apr 3 15:23:34 BST 2010

The GCS major value is as a monitoring device-- not a prognosticator nor (other perhaps than as a guide to intubate) for direction of acute care. Its major importance is for those of us who have to care for the patient down the line to let us know where we are and where we're going and where we've been. And I find a reliable GCS from the scene to be quite useful-- note the operate word reliable.

R Wigle MD FACS
LSUHSC

--- On Fri, 4/2/10, Doc Holiday <drydok at hotmail.com> wrote:

From: Doc Holiday <drydok at hotmail.com>
Subject: RE: Can you find some professional anomalies ?
To: ".Trauma List" <trauma-list at trauma.org>
Date: Friday, April 2, 2010, 12:30 PM

From: pbjorn at emh.org
> Bottom line: the AVPU is the GCS for those who can't add three one-digit numbers

--> As someone who teaches GCS to doctors and others on ATLS and other courses, I do like it for its uses and I appreciate its usefulness.

Of course, it is in itself a very limited tool and, with the availability of easier access to rapid CT imaging according to up-to-date guidelines, as well as current trends in airway management decision trees both pre- & in-hospital, GCS is even LESS useful than it used to be. Some of its commonest applications generally ignore its full scale and only look at but a few points in it. For example, we very commonly use it in the ED as if it only has THREE scores (15, 9-14, 3-8), or four scores (15, 14, 9-13, 3-8). Rather similar to AVPU, with its 4 points...

> It is the unnecessary dumbing-down of neurologic assessment

--> Actually, with good instruction, I have yet to find a healthcare professional who can master one and not the other - I don't consider one "dumber" than the other. I have, however, tested and found that most experts tend to take a few seconds longer to to a GCS than an AVPU.

I agree with what you say about trending, etc, but I must say that, working in the ED, at the early stages, AVPU seems to work remarkably well, which initially surprised me. A couple of years back we did a little exercise and "secretly" made decisions on patients in parallel using AVPU and found that, in 100% of cases (as in ALL), the AVPU decision in the bacground matched IN TERMS OF ACTUAL MANAGEMENT OF PATIENT IN THE ED the decisions the treating physician made using GCS.

AVPU is, indeed, GCS for eyes and this comes in handy when I teach GCS. I think it is also a very blunt tool, but don't throw it out yet - it is VERY quick and seems to work... No-one will force you to use AVPU if you know how to apply GCS, so no worry for you there. But no need to look down upon AVPU - I still find it handy...

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Can you find some professional anomalies ?