MEASUREMENT OF IMPAIRED CONSCIOUSNESS IN THE NEUROLOGICAL INTENSIVE-CARE UNIT - A NEW TEST

Neurological deterioration in alert patients with an acute CNS disorde r can be subtle, but current coma scales may not clearly capture chang es in level of alertness. Many coma scales include components such as eye opening and content of speech, features that are difficult to asse ss in intubated patients and patients with facial trauma. Two new tool s have been devised by the authors. The components are a continuous pe rformance test (patient is asked to raise his hand every time he hears a certain letter in a standardised sentence) and the three consecutiv e hand position test (''thumbs up-fist-victory sign''). Variation with in and between observers was assessed with three neurologists, two jun ior neurology residents, and two neuroscience nurses, and compared wit h the Glasgow coma score. The average agreements had comparable ranges for both scores, 65% to 89% for both tests and 60% to 88% for the Gla sgow coma score. On the first visit 49% of all tests with a maximum Gl asgow coma score had a negative continuous performance test as opposed to 13% of tests with a less than maximum Glasgow coma score. For the consecutive hand position test, these numbers were respectively 25% an d 2%. These tests may be a reasonable alternative to the Glasgow coma score to monitor patients, in particular when the verbal and eye respo nse cannot be reliably tested.