Which neurologic assessment in neurocritical care?

Abstract

In neurocritical care, neurologic clinic assessment is the best way to look after patients and use several scales and scores. These tools are numerous and varied. However, their use is not always relevant and can be deleterious for the patient (overstimulation, discomfort, pain). We look for the adaptation of the neurological evaluation and aims at keeping the best sensitivity while limiting the sources of discomfort for the patient.

First, in order to evaluate the practices of other units, a survey was carried out in several neurocritical care units. The questionnaire included 2 parts: the first one on the habits of the service (scales used, frequency of scoring), the second one on identified clinical situations (conscious patient, sedated patient, confused patient...).

It appears that the Glasgow coma scale remains the most used neurological rating scale, despite its limitations and constraints with respect to the patient. Moreover, there does not seem to be any adaptation of the choice of scoring tool and frequency to the patient's pathology and clinical condition.