Classification (Disturbance of Consciousness)

comm_1aEn_n.jpg to comm_1cEn_n.jpg: Classification of the severity of disturbance of consciousness. The severity of a disturbance of consciousness and time course can be determined by means of the following three aspects of behavior: comm_1aEn_n.jpg: Eye opening; comm_1bEn_n.jpg: Best verbal response or non-verbal reaction; and comm_1cEn_n.jpg: Best motorial response. Depending on the reaction in these three aspects, different scores can be assigned, the maximum being 15 in an awake and oriented patient. This evaluation can be performed anytime and independent of the examiner. In toddlers and infants the best non-verbal reaction can be used instead of the best verbal response. The younger the child, the more the face is in the foreground of clinical interest as the site of screening of the state of consciousness: Eye opening, fixation, and pursuit, miming, crying, smiling etc. In general, extracranial lesions, traumatic lesions of the head, therapeutic measures, and psychological behaviour may interfere with the evaluation of the severity of head trauma by the GCS; for instance, fracture of the extremities and swelling of the eyelids, or intubation, or anxiety.