Assessment of altered conscious level in clinical practice.

This article will critically appraise the literature focusing on the use and application of the Glasgow Coma Scale (GCS). Historically the GCS tool was created in a 14-point format and later revised to a 15-point format. Critical analysis of this potentially confusing aspect will be explored. The GCS tool enables the healthcare practitioner to effectively monitor the level of consciousness. The authors believe that anatomical and physiological knowledge is required to competently interpret assessment of level of consciousness. The article will review the anatomical basis of consciousness and consider some of the issues of application of GCS in practice, including painful stimuli.