ID

23593

Descrizione

Derived from www.openehr.org . Use to record clinical responses of an adult subject of care to stimuli. It is commonly used to establish a baseline conscious state and neurological function assessment and/or to detect patients who may require immediate medical intervention. The Glasgow coma scale has three subscales E (eye), V (verbal) and M (motor). In clinical practice all three subscales are reported individually plus the 'Total score', if applicable. A recorded response for each of E, V and M is mandatory. If a response cannot be tested, then the 'Not Applicable' null flavour should be recorded; do not use the 'None' ordinal value to record a missing component. Details about the reason for not being able to test a response can be recorded in the 'Confounding factors' data element. The 'Total score' can be derived as the sum of the recorded eye, motor and verbal response scores. It is not appropriate to report a 'Total score' when one or more components are not testable because the score will be artificially low - in this situation record the EVM profile instead. The three response values are considered separately as well as their sum. The 'EVM profile' can be derived as a concatenation of each of the recorded eye, motor and verbal response scores. For example, E3 V4 M2 represents the conscious state of a subject who opens eyes to speech, utters incomprehensible sounds and has an extensor response to stimulation. The minimum possible 'Total score' value is 3 (equivalent to E1 V1 M1) and the maximum possible is 15 (equivalent to E4 V5 M6). In practical use, Glasgow coma scale is recorded as one component of clinical monitoring, using sequential and repeated point-in-time measurements. Date and time should be recorded for each measurement, as well as any factors that may influence interpretation of changes. Changes in 'Total score' or any E, V or M values may have as much clinical significance as the value recorded initially.

collegamento

www.openehr.org

Keywords

  1. 09/07/17 09/07/17 - Martin Dugas
  2. 09/07/17 09/07/17 - Martin Dugas
  3. 09/07/17 09/07/17 - Martin Dugas
Caricato su

9 luglio 2017

DOI

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Licenza

Creative Commons BY-SA 3.0

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Glasgow Coma Scale (EHR Archetype)

openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1

  1. StudyEvent: openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1
    1. openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1
openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1.xml
Descrizione

openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1.xml

Glasgow Coma Scala
Descrizione

Glasgow coma scale

Tipo di dati

text

Alias
UMLS CUI [1]
C0017594
Beste sprachliche Antwort
Descrizione

Best verbal response

Tipo di dati

text

Alias
UMLS CUI [1]
C3648957
Beste motorische Reaktion
Descrizione

Best motor response

Tipo di dati

text

Alias
UMLS CUI [1]
C3648958
Augen öffnen
Descrizione

Best eye response

Tipo di dati

text

Alias
UMLS CUI [1]
C3648956
GCS Score
Descrizione

GCS score

Tipo di dati

integer

Alias
UMLS CUI [1]
C1271007
Kommentar
Descrizione

Comment

Tipo di dati

text

Alias
UMLS CUI [1]
C0947611
Confounder
Descrizione

Confounding factors

Tipo di dati

text

Alias
UMLS CUI [1]
C0009673

Similar models

openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1

  1. StudyEvent: openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1
    1. openEHR-EHR-OBSERVATION.glasgow_coma_scale.v1
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Glasgow coma scale
Item
Glasgow Coma Scala
text
C0017594 (UMLS CUI [1])
Item
Beste sprachliche Antwort
text
C3648957 (UMLS CUI [1])
Code List
Beste sprachliche Antwort
CL Item
keine Antwort (1)
C2012060 (UMLS CUI-1)
CL Item
unverständliche Laute (2)
C2012057 (UMLS CUI-1)
CL Item
Wortsalat (3)
C2012058 (UMLS CUI-1)
CL Item
verwirrt/ desorientiert (4)
C2012056 (UMLS CUI-1)
CL Item
voll orientiert (5)
C2012059 (UMLS CUI-1)
Item
Beste motorische Reaktion
text
C3648958 (UMLS CUI [1])
Code List
Beste motorische Reaktion
CL Item
keine Reaktion (1)
C2012054 (UMLS CUI-1)
CL Item
streckt auf Schmerzreiz (2)
C2012050 (UMLS CUI-1)
CL Item
beugt nicht normal auf Schmerzreiz (3)
C2012051 (UMLS CUI-1)
CL Item
beugt normal auf Schmerzreiz (4)
C2012052 (UMLS CUI-1)
CL Item
gezielte Abwehr auf Schmerzreiz (5)
C2012053 (UMLS CUI-1)
CL Item
führt Befehle aus (6)
C2012055 (UMLS CUI-1)
Item
Augen öffnen
text
C3648956 (UMLS CUI [1])
Code List
Augen öffnen
CL Item
keine Reaktion (1)
C2012045 (UMLS CUI-1)
CL Item
auf Schmerzreiz (2)
C2012047 (UMLS CUI-1)
CL Item
auf Anruf (3)
C2012048 (UMLS CUI-1)
CL Item
spontan (4)
C2012046 (UMLS CUI-1)
GCS score
Item
GCS Score
integer
C1271007 (UMLS CUI [1])
Comment
Item
Kommentar
text
C0947611 (UMLS CUI [1])
Confounding factors
Item
Confounder
text
C0009673 (UMLS CUI [1])

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