Kyoto

New assessment scale offers uniform standards to ascertain level of consciousness

XXIII WCN 2017, Kyoto, Japan, 16-21 September 2017

More than half a dozen different examination scales are currently in use worldwide for assessing the level of consciousness of critically ill patients. At the World Congress of Neurology in Kyoto, researchers of the USA presented a new, composite tool that enables uniform assessment and could contribute to improved communication between different disciplines.

Kyoto, September 2017 – A new, simple clinical examination can often ascertain the level of the patients’ consciousness in neuro-critical care units more precisely than the examination scales currently in use. This is the conclusion of a study presented at the XXIII World Congress of Neurology (WCN 2017). This major international scientific conference is taking place from September 16 to 21 in Kyoto. 

There are more than half a dozen different scales in use worldwide to determine the level of consciousness in people suffering from impaired consciousness. One problem is that although all of the clinical assessment methods have proven reliability, they each apply a different set of criteria and rationale, which can make accurate diagnosis more difficult in day-to-day clinical operations. 

“Neurologists, neurosurgeons, anaesthetists, psychiatrists, emergency rooms, intensive care units and prehospital disciplines all use differing terminology, different scales and different care routines for patients with impaired consciousness,” explained study author Dr Gregory Kapinos, Assistant Professor at Hofstra Northwell School of Medicine in Manhasset, USA. “There is no consensus on defining drops in level or content of consciousness.” 

To redress this situation, Dr Kapinos and his colleagues analysed the available examination scales. “We did not create a new assessment, but extracted the best components that were most pertinent or reliable from already standardized assessment methods,” Dr Kapinos says. “We also clarified the terminology used in different traditional scales.” The components extracted were recomposed into a larger new scale – the WCN scale. Established methods such as the Glasgow Coma Scale (GCS), the Richmond Agitation-Sedation Scale (RASS), the FOUR Score and the National Institutes of Health Stroke Scale (NIHSS) were compared with the newly composed tool. 

The results were impressive: whether grading alertness, measuring response to specific stimuli, determining attention span or ascertaining integrative processing speed, the composite WCN scale can outperform the traditional assessment tools. “Our composite assessment method delivers significantly more consistent and valuable results than the standardized assessment methods,” Dr Kapinos said as a conclusion. “This means that members of different medical disciplines and nurses in neurological care can reach conclusions about degree of consciousness that are congruent and free from contradiction. Compared to commonly used consciousness scales, our tool offers precise terminology and better clinical documentation, providing a basis for improved inter-professional communication. And any deterioration is detected earlier.”

Source: WCN 2017 Abstract Kapinos et al, Proposing The WCN Scale: A Comprehensive Composite Assessment Of Consciousness In The Critically Ill Patient


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