How often should the Glasgow Coma Scale (GCS) be charted in patients with suspected brain injury or impaired consciousness?

From the Guidelines

The Glasgow Coma Scale (GCS) should be assessed and documented every hour for patients with suspected brain injury or impaired consciousness, especially during the first 24 hours after injury or until the patient's condition stabilizes. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of regular GCS monitoring in detecting early changes in consciousness that might indicate worsening brain injury, increased intracranial pressure, or other complications requiring prompt intervention 1.

Key Considerations

• The GCS score is a crucial tool for assessing the severity of traumatic brain injury, and its components (eye opening, verbal response, and motor response) should be consistently documented to ensure effective communication among healthcare providers 1.
• The motor component of the GCS remains robust in sedated patients and is well correlated with the severity of head trauma, making it a reliable indicator of neurological function 1.
• For critically ill patients or those showing neurological deterioration, more frequent assessments (every 15-30 minutes) may be necessary, and any significant changes in GCS score (decrease of 2 or more points) should prompt immediate medical attention and more frequent monitoring 1.

Adjusting Monitoring Frequency

• After stabilization, the frequency of GCS assessments may be reduced to every 2-4 hours, and eventually to every 4-8 hours as the patient improves.
• The timing of GCS assessments should be adjusted based on the patient's clinical condition, with a focus on detecting early signs of neurological deterioration or improvement.

Importance of Regular GCS Monitoring

• Regular GCS monitoring provides an objective measure of neurological function and helps detect early changes in consciousness that might indicate worsening brain injury, increased intracranial pressure, or other complications requiring prompt intervention 1.
• Consistent documentation of GCS scores ensures effective communication among healthcare providers and allows for tracking the patient's neurological status over time.

From the Research

GCS Scale Charting

The frequency of charting the Glasgow Coma Scale (GCS) in patients with suspected brain injury or impaired consciousness is crucial for monitoring their condition and making informed decisions about their care.

• The GCS score is a primary method of assessing consciousness after traumatic brain injury (TBI) and is used to classify TBI severity 2.
• Studies have shown that the GCS score demonstrates circadian rhythmicity, with peak scores at 12 p.m. and nadir at 4 a.m. 2.
• Patients with lower GCS scores, particularly those admitted at midnight, are more likely to be admitted to the ICU and have a higher likelihood of alcohol abuse and drug intoxication 2.
• The FOUR score and GCS are comparable in terms of predictive ability for functional status, cognitive outcome, and in-hospital mortality in TBI patients 3.
• In children with head injury, decreasing levels of GCS are an important indicator for increasing risk of clinically important traumatic brain injury (ciTBI), neurosurgery, and death 4.
• For patients with minor head injury and a GCS score of 15, urgent neurosurgical intervention and precipitous deterioration are rare, but warning signs such as vomiting, restlessness, and severe headache may portend the need for urgent intervention 5.
• A GCS threshold of ≤5 is the point at which intubation in TBI patients confers an additional benefit in disposition without worsened outcomes of mortality, hospital length of stay, or ICU length of stay 6.

Charting Frequency

While there is no specific recommendation for the frequency of GCS charting, it is essential to monitor patients with suspected brain injury or impaired consciousness regularly to detect any changes in their condition.

• The frequency of GCS charting may vary depending on the patient's condition, with more frequent charting required for patients with lower GCS scores or those who are at higher risk of deterioration.
• Healthcare providers should use their clinical judgment to determine the appropriate frequency of GCS charting for each patient, taking into account their individual needs and circumstances.