Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale*

TLDR

Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU and AVPU) compared to each other and to the Glasgow Coma Scale. Neurosurgical nurses recorded patients’ conscious level with each of the three scales over 7 months, yielding 1,020 analysable measurements. Both simple scales mapped distinct GCS ranges with some overlap (p < 0.001); median GCS scores were 15, 13, 8, 6 for AVPU and 15, 13, 10, 6 for ACDU, indicating that ACDU’s more evenly distributed scores may better detect early consciousness deterioration in critically ill ward patients.

Abstract

Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU - Alert, Confused, Drowsy, Unresponsive; and AVPU - Alert, responds to Voice, responds to Pain, Unresponsive) compared to each other and also to the more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded patients' conscious level with each of the three scales. Over 7 months, 1020 analysable measurements were collected. Both simple scales identified distinct GCS ranges, although some overlap occurred (p < 0.001). Median GCS scores associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6. The median values of ACDU were more evenly distributed than AVPU and may therefore be better at identifying early deteriorations in conscious level when they occur in critically ill ward patients.