Disturbance of consciousness in acute stage, so far, has been classified by using a set of technical terms such as coma, stupor, somnolence, confusion and so on. However, the definition of such terms has a different nuance from one clinic to another, and this made the comparison of the data on the same topics incomplete and incorrect. Because of this, it is true in most neurosurgical clinics in Japan that the severity of the disturbance of consciousness has long been described with grades of the responsiveness to different stimuli laden to the patients.
In order to obtain an universal classification on this matter, possibility ef quantitative and qualitative gradings has been searched by means of combining the following three factors; arousal, responsiveness to mechanical and verbal stimuli, and the contents of consciousness. Table shows our proposal of quantitative and partially qualitative grading of the disturbance of consciousness in acute stage. Deep coma, coma and semicoma in the contemporary usage belong to grade III in our classification; stupor, lethargy, hypersomnia, somnolence, and drowsiness belong to grade II, and delirium, confusion, and senselessness belong to grade I.
Features of this new grading of the disturbance of consciousness in acute stage have been discussed.
Table: New grading of level of consciousness in acute stage (So-ocalled 3-3-9 formula) Grade III. The patient is unable to be arousen with any forceful mechanical stimulus, and
(300) 3. is not responsive at all except for change of respiratory rhythm,
(200) 2. is responsive with slight movements including decerebrate response, or
(100) 1. is responsive with combative oropurposeful movements.
Grade II. The patient is able to be arousen with mechanical or verbal stimuli, and
(30) 3. is barely arousen with repeated mechanical stimuli,
(20) 2. is arousen with loud voice or shaking shoulders, or
(10) 1. is arousen easily with usual voice.
Grade I. The patient is awake without any stimulus, and
(3) 3. is quite senseless and cannot tell even his own name or date of birth,
(2) 2. is disorientated to time, place, and person, or
(1) 1. is seemingly alert but not fully so. “R” and“Inc” are added to the grading in case of restlessness and incontinence.
