The ACVPU Scale

The ACVPU scale is a rapid method of assessing a patient’s level of consciousness. Assessing level of consciousness using ACVPU is part of calculating a patient’s early warning score (NEWS2) alongside their basic observations (vital signs). 

If a more detailed assessment of a patient’s level of consciousness is required (e.g. following a head injury), the Glasgow Coma Scale (GCS) should be used. 

What does ACVPU stand for?

ACVPU stands for:

• Alert
• Confusion (new)
• Voice
• Pain
• Unresponsive

ACVPU vs AVPU

AVPU was the original method of rapidly assessing level of consciousness, and this scale is still commonly referred to. With the development of NEWS2, new-onset confusion (‘C‘) was added to the score to make ACVPU. 

Patients who develop new or worsening confusion (e.g. delirium) are at risk of deterioration. Therefore, identifying and implementing appropriate treatment for these patients is important.

The ACVPU scale

To use the ACVPU scale, choose the description which bests describes the patient’s level of consciousness. 

Alert

The patient is fully awake and at their baseline level of cognition.

Confusion (new)

The patient is awake but disorientated or confused (this must be new-onset or worse than their baseline level of confusion). 

Verbal

The patient demonstrates some form of response when you talk to them (e.g. words, grunting, moving a limb).

Pain

The patient responds to a painful stimulus (e.g. supraorbital pressure).

Unresponsive

The patient does not respond to a painful stimulus.

Interpreting ACVPU

New onset confusion, or a deteriorating level of consciousness, is a red flag for serious illness and requires urgent escalation. An ABCDE approach can be used to assess and manage these patients. 

In the NEWS2 scale, a score of three is given for patients who are CVPU (i.e. any patient who is not fully awake). 

It is important to document the ACVPU score in the medical notes and/or NEWS2 chart. In patients who are not fully awake, consider calculating a Glasgow Come Scale (GCS) score for a more accurate assessment of their level of consciousness. 

References

• The Royal College of Physicians. National Early Warning Score (NEWS) 2. 2017. Available from: [LINK]