Rapid and accurate assessment of impaired consciousness is very important especially for emergent patients. For early diagnosis and treatment of patients with altered mental state, it is essential for emergency physician to provide a guide to
ultimate
outcome and to communicate the patient's information between medical personnels. We have evaluated and compared three mothods that are mostly used in clinic for assessing the impaired consciousness in order to find out the most objective method
which
may not be influenced by individual medical knowledge and training. Three months (Oct, 1993 and Jan to Feb, 1994) of assessments by 3 observant groups(a 1st-year resident of dept. of emergency medicine, an intern, and a senior student of medical
college) were made to 78 patients with altered mental state(ages above 15), who have been admitted to the department of emergency medicine, Severance Hospital Yonsei University College of Medicine. The methods under comparison were 5-scale
method,
AVPU
method, and Glasgow coma scale(GCS). The results are as follows;
The patients population ranged from 19 to 89 with an average of 55.8 yrs. 54% of the patients were older than 60 years of age. The causes of emergency visit were disease(69%), trauma(23%), and intoxication(8%). The causes of the disease include
intracranial hemorrhage (40%), cerebral infarction(9%), and medical illness(20%). McNemar test showed no statistical significance between any of these comparisons. Kappa-value, the reliability was highest at the resident-intern group assessed by
the
AVPU method(0.782) and lowest at the resident-student group measured by the 5-scale method(0.582). These values were, however, above the "fair to good agreement" level indicating that all the methods can be used for assessment of impaired
consciousness
with objectiveness. The ranks of comparison groups in each methods were in the following order of magnitude. (1) 5-scale method: resident-intern, intern-student, resident-student, (2) AVPU method: resident-intern, resident-student,
intern-student,
(3)
GCS: intern-student, resident-intern, resident-student, The ranks of compared methods in each groups were, (1) resident-intern: AVPU method, 5-scale method, GCS, (2) resident-student: AVPU method, GCS, 5-scale method, (3) intern-student: GCS,
5-scale
methods, AVPU method.
These results suggests that, the most objective method not influenced by medical knowledge and training is AVPU method, showing highest reliability especially in the resident-student group with greatest difference in the level of medical
knowledge
and
training.
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