AVPUSystem

The AVPU system is a concise clinical scale used to classify a patient’s level of consciousness and responsiveness. It comprises four categories: Alert, Verbal response, Pain response, and Unresponsive.

The scale is widely used in prehospital care, emergency departments, and intensive care units as a rapid initial assessment and ongoing monitoring tool. It helps clinicians quickly document changes in consciousness and communicate patient status. AVPU is often employed when a full neurological examination is not feasible, and it can be used alongside more detailed scales such as the Glasgow Coma Scale (GCS).

Definitions and criteria

- Alert: the patient is awake or easily aroused, responsive, and oriented to person, place, and time.

- Verbal: the patient responds to spoken requests or commands but may not be fully oriented.

- Pain: the patient does not respond to verbal stimuli but grimaces, withdraws, or shows a motor response to a painful stimulus (such as a controlled pinch).

- Unresponsive: there is no meaningful response to voice or pain.

Relationship to other scales and limitations

AVPU is simpler and faster to apply than the Glasgow Coma Scale, making it useful for rapid triage and serial assessments. However, its coarse categories provide less granularity and may overlook subtle or evolving neurological deficits. Sedation, intoxication, intoxication, or severe motor impairment can affect classification. It is not intended as a sole prognostic tool and may be supplemented with more detailed neurological exams or scores as patient status allows. In pediatric settings, AVPU adaptations and pediatric-specific assessments are sometimes used to account for developmental differences.

See also Glasgow Coma Scale, FOUR score.