Utilization of the Glasgow Coma Scale and Jouvet Coma Scale to evaluate the level of consciousness

Abstract

The Glasgow Coma Scale (GCS) and the Jouvet Coma Scale (JCS) have been evolved for assessing the depth and duration of impaired consciousness and coma. The analysis and the utilization of these scales have showed that they are complementary. The GCS is more sensitive when there is a more intense loss of consciousness, whereas the JCS shows its sensitivity better in the states close to normal. This study was aimed to compare the results obtained from the evaluation of the consciousness level by the utilization of the two scales. The comparison was done within a prospective study with 48 patients, all of them over 18 years old, interned in three intensive care units of different hospitals in the city of São Paulo . The evaluations were done daily by the researchers and the scales applied in sequence totaling 5 minutes. Each scale was applied in 106 evaluations, and the results showed a statistically meaningful difference between the GCS and the JCS as to the indication of alteration in the consciousness levels. In 37.74% of the evaluations done with the JCS there was an indication of alteration in the consciousness level, whereas with the GCS the alteration was present in only 23.58% of the evaluations. Another important observation about the utilization of both scales was that people whose scores were between 9 and 10 in the GCS had had an stronger indication of alteration of consciousness level by the same scale, while those with scores between 12 and 15 had a stronger indication of alteration in the consciousness level by JCS. When using GCS there has been the application of the non-testable (NT) in 20% of the evaluations. This did not occur when using the JCS. However it is believed that specific conditions of that particular group might have led to that result as well as specific characteristics of groups of patients might favor the utilization of different scales to evaluate the consciousness level. Therefore the final choice between such scales should consider the conditions and the peculiar characteristics of the clientele to be evaluated and not individual or health department services preferences.