Changes in level of consciousness may be overt (unconscious) or subtle (personality change) and may reflect a variety of factors. AVPU is simple to use and has been shown to be better at identifying early deterioration in conscious level when occurring in critically ill ward patients (4)
A number of other systems have been used to assess and document changes in level of consciousness associated with specific conditions or interventions. For example, sedation scores have been validated to detect the impact of sedative drugs like opioids but have not been validated for detecting changes in level of consciousness from other causes (such as infection, hypotension or hypercapnia) (5)
Similarly, the Glasgow Coma Scale
(GCS) was developed as a tool for assessing patients with neurological injury. As a relatively complex scoring system, it has been shown to have significant interrater variability (6)
. For patients with specific neurological injury, the individual components of the GCS are required. Within tertiary hospitals, such patients are usually managed in specific neurosurgical or neurology wards where clinicians are more familiar with the complexity of the GCS.