The AVPU scale (an acronym from "alert, verbal, pain, unresponsive") is a system by which a health care professional can measure and record a patient's
level of consciousness.
It is mostly used in emergency medicine protocols, and within
first aid
First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
.
It is a simplification of the
Glasgow Coma Scale, which assesses a patient response in three measures:
eye
An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system.
In higher organisms, the ey ...
s,
voice
The human voice consists of sound made by a human being using the vocal tract, including talking, singing, laughing, crying, screaming, shouting, humming or yelling. The human voice frequency is specifically a part of human sound produ ...
and
motor skill
A motor skill is a function that involves specific movements of the motor system, body's muscles to perform a certain task. These tasks could include walking, running, or riding a bike. In order to perform this skill, the body's nervous system, m ...
s. The AVPU scale should be assessed using these three identifiable traits, looking for the best response of each.
Meaning of the mnemonic
The AVPU scale has four possible outcomes for recording (as opposed to the 13 possible outcomes on the
Glasgow Coma Scale). The assessor should always work from best (A) to worst (U) to avoid unnecessary tests on patients who are clearly conscious. The four possible recordable outcomes are:
[
* Alert: The patient is fully awake (although not necessarily oriented). This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function.
* Verbal: The patient makes some kind of response when you talk to them, which could be in any of the three component measures of eyes, voice or motor – e.g. patient's eyes open on being asked "Are you OK?". The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the rescuer.
* Pain: The patient makes a response on any of the three component measures on the application of pain stimulus, such as a central pain stimulus like a sternal rub or a peripheral stimulus such as squeezing the fingers. A patient with some level of consciousness (a fully conscious patient would not require a pain stimulus) may respond by using their voice, moving their eyes, or moving part of their body (including abnormal posturing).
*Unresponsive: Sometimes seen noted as ' unconscious', this outcome is recorded if the patient does not show any eye, voice or motor response to voice or pain.
In ]first aid
First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
, an AVPU score of anything less than A is often considered an indication to get further help, as the patient is likely to be in need of more definitive care. In the hospital or long term healthcare facilities, caregivers may consider an AVPU score of less than A to be the patient's normal baseline.
In some emergency medical services
Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to d ...
protocols, "Alert" can be subdivided into a scale of 1 to 4, in which 1, 2, 3 and 4 correspond to certain attributes, such as time, person, place, and event. For example, a fully alert patient might be considered "alert and oriented x 4" if they could correctly identify the time, their name, their location, and the event.
EMS crews may begin with an AVPU assessment, to be followed by a GCS assessment if the AVPU score is below "A."
Limitations
The AVPU scale is not suitable for long-term neurological observation of a patient; in this situation, the Glasgow Coma Scale is more appropriate.
Comparison with other classification systems
When compared to the Glasgow Coma Scale (GCS) the AVPU classification of alertness has been suggested to correspond in the following manner:
* Alert = 15 GCS
* Voice Responsive = 13 GCS
* Pain Responsive = 8 GCS
* Unconscious/DOA = 3 GCS
(Kelly, Upex and Bateman, 2004)
References
{{Reflist
Diagnostic emergency medicine
First aid